Tuberculosis  Among  the  Nebraska 
Winnebago 


A  Social  Study  on  an  Indian  Reservation 


By  Margaret  W.  Koenig,  M.  D. 


With  Illustrations  and  Charts 


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Published  by  the  Nebraska 
State  Historical  Society 

Lincoln,  Nebraska 


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Tuberculosis  Among  the  Nebraska 
Winnebago 


A  Social  Study  on  an  Indian  Reservation 


By  Margaret  W.  Koenig,  M.  D 


With  Illustrations  and  Charts 


Published  by  the  Nebraska 
State  Historical  Society 

Lincoln,  Nebraska 
1921 


KG 


Copyright  1921 
By  Nebraska  State  Historical  Society 
Lincoln,  Neb. 


»ri|N  FT«.  CO..  UNIVERSITY  PLACE.  NilK. 


INTRODUCTION 


The  Winnebago  is  one  of  the  tribes  known  longest  and 
least  by  white  men.  Upon  the  Omaha,  Pawnee,  Cheyenne 
and  Kiowa  tribes  there  is  an  extensive  literature,  represent- 
ing years  of  close  contact  and  study  by  scientific  scholars, 
but  neither  in  Nebraska  nor  in  Wisconsin  has  the  Winne- 
bago received  similar  attention.  No  careful  scientific  study 
of  the  Winnebago  language  and  its  relationship  to  other 
Indian  tongues  had  been  made  until  the  preliminary  work 
of  Dr.  Paul  Radin  of  Columbia  University  about  ten  years 
ago. 

The  exiled  wanderings  of  the  Winnebago  from  their  old 
Wisconsin-Minnesota  home  to  their  final  Nebraska  location 
make  a  story  as  romantic  and  tragic  as  that  told  by  Helen 
Hunt  Jackson  in  Ramona. 

No  further  emigration  is  possible  for  the  tribe  upon 
this  planet.  It  must  survive  or  perish  where  it  now  is.  In 
Nebraska  its  fate  is  closely  connected  with  that  of  its  white 
neighbors.  The  battle  for  the  life  of  the  Winnebago  tribe 
is  therefore  a  battle  for  Nebraska. 

This  study  of  the  Nebraska  Winnebago  by  Dr.  Margaret 
W.  Koenig  is  one  of  vital  importance  to  our  state.  The  Ne- 
braska State  Historical  Society  gladly  welcomes  it  to  its 
list  of  publications. 

Most  of  the  photographs  used  in  the  illustrations  are  from 
the  camera  of  Frank  H.  Shoemaker,  one  of  the  most  success- 
ful artists  in  dealing  with  nature.  A  special  winter  trip  to 
Winnebago  was  made  for  some  of  them. 

July  20,  1921.  Addison  E.  Sheldon, 

Supt.  Nebraska  State  Historical  Society. 


do 


FOREWORD 

,  The  seedthought  for  this  study  originated  with  Mrs.  K. 
R.  J.  Edholm,  executive  secretary  of  the  Nebraska  Tubercu- 
losis Association.  It  was  conducted  in  co-operation  with 
the  Department  of  Sociology  of  the  University  of  Ne- 
braska, and  the  field  work  was  financed  by  the  National 
Tuberculosis  Association.  The  purpose  was  to  ascertain  by 
direct  investigation,  first-hand  facts  and  conditions  pertain- 
ing to  Winnebago  Indian  life,  with  particular  reference  to 
tuberculosis.  To  this  end  a  field  study  was  made  on  the 
reservation  during  the  months  of  July  and  August,  1919. 

It  is  hoped  that  the  publication  of  this  study  may  arouse 
public  interest  to  such  an  extent  that  substantial  assistance 
will  be  given  the  government  in  carrying  out  its  constructive 
health  program  for  the  physical  welfare  of  our  Indian 
friends. 

My  deep  appreciation  and  thanks  are  extended  to  all  those 
who  have  entered  into  the  spirit  of  the  work  and  have  fur- 
nished information  and  other  aid.  A  large  share  of  the  suc- 
cess of  this  report  is  attributed  to  the  government  and 
mission  workers  on  the  reservation  and  the  Indians,  who  re- 
sponded so  willingly  and  cheerfully  in  the  promotion  of  the 
work,  and  without  whose  generous  help  the  collection  of  this 
data  would  not  have  been  possible.  Especial  recognition  is 
due  Mrs.  Addie  Boucher,  Winnebago  Indian  nurse,  and  Miss 
Anna  Berkenpas,  nurse  and  field-worker  for  the  Dutch  Re- 
formed Mission,  for  their  invaluable  personal  services ;  and 
Superintendent  C.  D.  Munro,  who  placed  the  records  of 


♦ 


VI  Nebraska  State  Historical  Society 

the  agency  at  my  disposal,  and  extended  other  courtesies. 
Grateful  acknowledgment  is  made  to  the  Commissioner  of 
Indian  Affairs  for  his  co-operation;  to  the  Nebraska  State 
Historical  Society  for  providing  the  illustrations;  to  Harry 
H.  Laughlin  of  the  Eugenics  Record  Office,  Cold  Spring 
Harbor,  Long  Island,  New  York,  and  Dr.  H.  J.  Lehn- 
hoff  of 'Lincoln,  Nebraska,  who  read  the  manuscript  of  the 
following  pages  and  gave  the  benefit  of  their  criticism.  I 
am  under  the  deepest  obligation  to  Dr.  Hattie  Plum  Will- 
iams, Associate  Professor  of  Practical  Sociology  in  the 
University  of  Nebraska,  for  her  personal  interest  and  in- 
valuable assistance  in  the  preparation  of  this  material. 


Lincoln,  Nebr.,  July,  1921. 


Margaret  W.  Koenig. 


CONTENTS 


Chapter  I.   Historical  and  Sociological  Background. 

1.  The  Winnebago  Tribe   1 

2.  The  Winnebago  in  Nebraska   4 

Chapter  II.   Incidence  of  Tuberculosis. 

1.  Basis  of  Data  ..  17 

2.  Mortality  and  Morbidity  Rates  19 

3.  Classification  of  Tuberculosis  Cases  21 

Chapter  III.    Factors  Among  the  Winnebago  Predispos- 
ing to  Tuberculosis. 

1.  Home  Sanitation    .  31 

2.  Social  Customs   35 

3.  Use  of  Stimulants    36 

4.  Allied  Diseases   38 

Summary      ,  ...  42 

Appendix — Family  Distribution  of  Tuberculosis  46 

TABLES 

Page 

I.    Showing  Movement  of  Population,  1909-1919   5 

II.    Showing  Distribution  of  Families  and  Permanent 

Houses        8 

III.  Showing  Distribution  of  Population  per  Degree  of 

Blood       9 

IV.  Showing  Number  of  Winnebago  Employed  in  Gain- 

ful Occupations,  September,  1919...   14 

V.    Mortality  and  Morbidity  from  Tuberculosis  among 

Winnebago,  1909-10  to  1918-19  ..  .Opposite  20 

yi.    Showing  Age  Distribution  of  237  Cases  of  Tuber- 
culosis among  the  Winnebago,  1909-1919.....  22 

VII.    Forms  of  Tuberculosis  in  237  Cases  among  the 

Winnebago,  1909-1919...  24 

VIII.    Showing  Number  of  Deaths  from  Tuberculosis  by 

Seasons,  1909-1919  32 


\ 

VIII  Nebraska  State  Historical  Society 

CHART  AND  MAPS 

Page 

Location  of  Winnebago  Reservation  in  Nebr  Opposite  4 

Distribution  by  Age  Periods  and  Sex  Groups  of 

Winnebago,  1919,  1913  Opposite  8 

Thurston  County  Showing  Winnebago  Reser- 
vation .  ;  _  Opposite  48 

ILLUSTRATIONS 

Page 

Winnebago  Indian  Agency   Frontispiece 

Upper — Winnebago  Mother  and  Child  {  facing  10 

Lower — Mending  Day  J.  " 

Winnebago  Farm  Buildings   facing  13 

Types  of  Winnebago  Travel  facing  15 

Winnebago  Indian  Graves     facing  16 

Indian  Hospital  and  Grounds    facing  18 

An  Indian  Hogan..  ....facing  26 

Modern  Winnebago  Homes  facing  31 

Interior  Views  facing  32 

A  Sick  Winnebago  Asleep  ....facing  33 

Mescal  Buttons  (Peyote)   .  facing  36 

Upper — Native  Tent  Abode  ] 

Middle — Primitive  Bark  Hut    y  ..facing  40 

Lower — Summer  Quarters  J 


CHAPTER  I 


HISTORICAL  AND  SOCIOLOGICAL  BACKGROUND 
1.    The  Winnebago  Tribe 

The  Winnebago  are  a  branch  of  the  great  Siouan  linguis- 
tic family  of  North  American  Indians.1  They  have  been 
known  to  the  whites  since  about  1634  when  they  were  lo- 
cated in  the  timber  and  lowlands  bordering  on  Lake  Winne- 
bago in  east  central  Wisconsin.  From  the  nature  of  their 
habitat  they  were  forest  Indians,  living  in  a  more  or  less 
settled  state.  Their  dwellings  were  permanent  bark  or 
mat  wigwams.  They  engaged  in  agriculture,  corn  being  the 
chief  product,  and  in  fishing  and  trapping.  Their  activities 
as  fur  traders  figured  prominently  in  the  early  history  of  the 
locality  where  they  had  lived  for  generations  in  comfort  and 
happiness.  They  were  at  this  time  described  by  travelers 
and  missionaries  as  a  "prosperous  people,"  a  fine-looking 
and  stalwart  race. 

After  two  centuries  of  undisturbed  residence  misfortune 
overtook  them.  They  had  suffered  the  usual  tragedies  of 
Indian  tribes.  Several  times  their  ranks  had  been  decimated 
and  their  tribal  strength  reduced  by  war,  famine,  and  dis- 
ease. In  their  contact  with  unprincipled  and  heartless 
whites — licensed  traders  and  liquor  dealers — they  had  ex- 
perienced, now  and  again,  the  loss  of  "their  money,  their 
goods,  their  food,  their  clothing,  their  virtue,  and  their 
health."  Finally  the  rapid  advance  of  white  settlers  follow- 
ing the  Black  Hawk  War  (1832)  had  resulted  in  the  forced, 
sale  of  their  lands  to  the  United  States  in  1837.  But  their 
peculiar  misfortune  lay  in  the  fact  that  for  a  generation 

'The  chief  sources  for  the  history  of  the  Winnebago  are:  Report 
of  Commissioner  of  Indian  Affairs  for  the  years  1845,  1846,  1847, 
1862,  1864,  1865,  1867  and  1869;  Handbook  of  American  Indians; 
Lawson,  P.  V.  "The  Winnebago  Tribe,"  in  Wisconsin  Archeologist, 
VI,  78-114. 


2 


Nebraska  State  Historical  Society 


following  the  forced  migration  from  their  native  habitat, 
the  Winnebago  were  without  a  permanent  home.  Settled  by 
the  government  in  no  less  than  five  different  locations  they 
finally  separated  voluntarily,  some  throwing  themselves 
upon  the  charity  of  a  neighboring  tribe  and  others  wander- 
ing back  to  their  original  haunts. 

The  first  removal  was  made  under  protest,  the  tribe  re- 
pudiating the  sale  of  their  lands  and  claiming  that  the  en- 
voys were  not  authorized  to  arrange  for  their  transfer.  In 
spite  of  their  objections,  part  of  the  tribe  was  forcibly 
moved  to  their  new  location  in  northeastern  Iowa  in  1840. 
The  open,  timberless  country  was  a  distinct  change  from 
their  forest  home  and  there  was  much  suffering  from  im- 
proper housing,  insufficient  food  and  disease.  In  1846  this 
group  was  removed  to  a  reservation  at  Long  Prairie,  Minne- 
sota. Again  the  location  proved  unsuitable  and  ill-adapted 
to  their  native  needs  and  most  of  them  scattered  through- 
out the  state.  In  1855,  1300  Winnebago,  some  from  Wis- 
consin and  some  of  those  scattered  throughout  Minnesota, 
were  placed  on  a  reservation  at  Blue  Earth,  Minnesota,  a 
location  of  their  own  choice  and  most  highly  valued  by  them. 
Here,  in  an  environment  suited  to  their  nature,  they  quickly 
began  to  recover  and  to  regain  some  of  their  former  pros- 
perity. 

But  misfortune  pursued  them  in  the  guise  of  the  terrible 
"Sioux  Massacre"  of  1862.  Although  the  Winnebago  took 
no  part  in  the  affair,  and  even  though  they  offered  their  ser- 
vices in  punishing  the  Sioux,  the  frightened  inhabitants  of 
Minnesota  demanded  the  removal  of  all  Indians.  This  was 
provided  for  by  a  special  Act  of  Congress,  February  21, 1863, 
which  designated  Crow  Creek,  near  Pierre,  South  Dakota 
as  their  reservation.  The  removal  was  carried  out  in  a  most 
cruel  manner.  An  official  of  the  Indian  service  describes  it 
thus  in  a  report  to  the  Commissioner  of  Indian  Affairs:1 
"Hurried  from  their  comfortable  homes  in  Minnesota,  in 
1863,  almost  without  previous  notice,  huddled  together  on 


'Report  of  the  Commissioner  of  Indian  Affairs  for  the  year  1865, 

410. 


Tuberculosis  Among  the  Winnebago  3 


steamboats  with  poor  accommodations,  and  transported  to 
the  Crow  Creek  agency,  in  Dakota  Territory,  at  an  ex- 
pense to  themselves  of  more  than  $50,000,  they  were  left, 
after  a  very  imperfect  and  hasty  preparation  of  their  new 
agency  for  their  reception,  upon  a  sandy  beach  on  the  west 
bank  of  the  Missouri  river,  in  a  country  remarkable  only 
for  the  rigors  of  its  winter  climate  and  the  sterility  of  its 
soil,  to  subsist  themselves  where  the  most  frugal  and  in- 
dustrious white  man  would  fail  five  years  in  every  six  to 
raise  enough  grain  upon  which  to  subsist  a  family." 

In  addition  to  physical  hardship  the  Winnebago  suffered 
mental  distress.  They  believed  that  their  loyalty  to  the 
government  should  have  entitled  them  to  consideration  and 
kind  treatment.  When  they  became  convinced  that  public 
opinion  demanded  their  leaving  the  home  to  which  they  had 
become  attached,  they  were  assured  by  the  government  that 
it  would  place  them  in  a  location  as  favorable  as  the  one 
which  they  were  leaving.  Not  only  did  it  fail  to  keep  its 
promise  to  them  in  this,  but  it  stupidly  placed  their  en- 
emy, the  Sioux,  upon  the  same  reservation  to  be  occupied 
jointly  by  the  two  tribes. 

Broken  in  health  and  in  spirit,  the  Winnebago  faced  the 
alternative  of  abandoning  the  agency  or  dying  from  cold 
and  starvation.  They  chose  to  leave  and  in  the  winter  of 
1863-64  many  made  their  way  to  the  Omaha  reservation  in 
northeast  Nebraska,  arriving  there  in  a  destitute  condition.' 
A  large  number  died  of  cold  and  hunger  on  the  way.  Out 
of  2000  taken  to  Crow  Creek,  over  1200  had  reached  the 
Omaha  reservation  by  September,  1864.  Many,  through 
fear  of  the  Sioux,  fled  from  Crow  Creek  and  wandered  about 

'Thomas  L.  Sloan,  President  of  the  Society  of  American  Indians, 
says  of  their  arrival:  "When  they  came  to  this  location  they  were 
affected  with  tuberculosis,  syphilis  and  other  diseases.  Many  of  them 
had  scrofulous  sores  on  their  faces,  necks  and  bodies.  At  the  time 
they  came  here  and  for  many  years  after,  their  necessities  were  such 
that  they  went  about  the  country  picking  up  domestic  animals  that 
had  died  and  used  the  flesh  for  food.  It  was  particularly  noticeable 
that  as  soon  as  they  set  to  work  farming  and  procured  means  from 
their  labor  they  improved  in  their  habits,  health  and  general  appear- 
ance." 


4 


Nebraska  State  Historical  Society 


through  the  white  settlements.  Most  of  the  remainder 
scattered  into  their  old  haunts  in  Wisconsin  among  their 
native  woods  and  streams  where,  without  a  reservation  and 
in  defiance  of  several  attempts  on  the  part  of  the  govern- 
ment to  remove  them,  they  remain  to  this  day.4 

2.    The  Winnebago  in  Nebraska 

As  suggested  above,  the  Winnebago  tribe  of  Indians  con- 
sists today  of  two  groups,  the  Wisconsin  and  the  Ne- 
braska. It  is  of  the  latter  group  that  this  study  is  made. 
These  Winnebago  are  located  on  a  reservation  in  Thurston 
County,  Nebraska,  twenty-four  miles  southwest  of  Sioux 
City,  Iowa.  This  reservation  was  secured  for  them  March 
6,  1865,  through  the  negotiation  of  a  treaty  made  by  the 
United  States  government  with  the  Omaha  tribe  who  then 
owned  the  land.  It  comprises  a  strip  about  seven  miles 
wide  and  twenty-four  miles  long,  extending  east  and  west 
and  traversed  from  north  to  south  by  creeks  bordered  with 
abundant  timber.  Forest-clad  hills  and  secluded  fertile 
valleys  are  numerous.  The  Missouri  river  flows  along  the 
eastern  edge.  There  are  327  miles  of  highway.  The  Winne- 
bago being  forest  Indians,  the  general  topography  of  this 
location  is  well  adapted  to  their  native  environment. 

The  Winnebago  Indian  Agency  nestles  in  a  beautiful 
valley  near  the  center  of  the  reservation.  Here  are  grouped 
the  government  buildings,  including  the  central  office  or 
administration  building,  the  commissary,  laundry,  hospital, 
and  homes  of  the  employees.  Across  the  creek  from  the 
agency  is  the  Dutch  Reformed  Mission  which  maintains 
dormitories  for  the  Indian  children  attending  its  school. 
A  mile  and  a  half  distant  is  the  village  of  Winnebago  where, 
on  prominences  overlooking  the  countryside,  are  located  the 
Catholic  and  Episcopal  Missions. 


4According  to  the  Handbook  of  American  Indians,  in  1910  there 
were  1063  Winnebago  in  Nebraska  and  1270  in  Wisconsin. 


Tuberculosis  Among  the  Winnebago  5 


According  to  the  agency  records,  there  were  1078  Winne- 
bago enrolled  in  19 19.5  In  addition  to  the  Indian  population, 
the  reservation  contains  a  number  of  whites  who  lease  the 
Indian  land,  maintain  business  enterprises  in  the  village, 
or  are  employed  about  the  agency.  The  proportion  of 
whites  is  growing  rapidly,  while  the  Indian  population  is 
stationary.    The  following  table,  arranged  from  the  local 


Table  I.    Showing  Movement  of  Population,  1909-1919* 


YEAH 


1909- 
1910- 
1911- 
1912- 
1913- 
1914- 
1915- 
1916- 
1917- 
1918- 


1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 


Male 


£85 
593 


579 
582 


Female 


501 


506 


507 

496 


Total 


1057 
1086 
1077 
1099 
1090 
1098 
1096 
1105 
1086 
1078 


Incr.  or 

Deer, 
over 

Preced- 
ing 

Year 


+29 

—  9 
+22 

—  9 

;+  8 

—  2 
+  9 
—19 


Births 


57 
52 
36 
38 
31 
39 
32 
21 
26 


Deaths 


39 
43 
3tf 
30 
31 
40 

51 
44 


Incr.  or 
Deer,  of 
Births 
over 
Deaths 


+  18 
+  9 

—  1 
+  8 

0 

—  1 

—30 
—18 


Total   332 


315 


census  records,  shows  the  movement  of  the  Indian  popu- 
lation during  the  past  decade.  In  1919  there  was  an  in- 
crease over  1910  of  only  twenty-one  inhabitants,  every  al- 
ternate year  of  the  decade  showing  an  actual  decrease  in 
the  Indian  population.  The  birth  and  death  records,  though 
they  do  not  check  with  the  census,  corroborate  this  general 
tendency  toward  tribal  decay.  The  seven  years  for  which 
\>oth  data  are  given  show  an  excess  of  fifteen  deaths  over 

BThe  census  for  1919  shows  only  1068  names:  578  males  and  490 
females.  A  recent  examination  of  other  documents  by  agency  officials 
disclosed  the  names  of  ten  children,  under  five  years,  omitted  from 
the  roll.  The  revised  figures  are  substituted  in  the  table  and  used 
as  a  basis  for  computation  throughout  the. study. 

"Winnebago  Indian  Agency,  Local  Census  Records,  1909-1919. 


6 


Nebraska  State  Historical  Society 


births/  Incomplete  as  the  records  probably  are,  they  show 
an  abnormally  high  death  rate,  the  average  for  the  eight 
years  being  36.2  per  1000  or  two  and  one-half  times  the 
rate  for  the  registration  area  of  the  United  States.  The 
birth  rate  for  the  same  period,  computed  on  the  official  data, 
is  34.4  per  1000.  While  this  is  a  high  birth  rate,  it  is  ob- 
viously too  low,  since  it  does  not  permit  even  the  slight  in- 
crease shown  in  the  enrollment.  There  are  no  available 
records  by  which  to  trace  the  cause  for  the  very  high  death 
rate  and  the  resulting  fact  that  the  population  is  stationary ; 
but  every  indication  points  to  a  high  infant  mortality  as 
one  of  the  most  important  factors.  An  agency  official  states 
that  she  knows  of  but  two  Indian  mothers  who  have  not 
lost  one  or  more  of  their  children.  In  spite  of  a  high  birth 
rate,  the  Winnebago  family  is  small,  having  less  than  two 
children  per  family.8  Many  instances  were  found  in  which 
a  mother  had  borne  ten  to  twelve  children,  and  several 
cases  were  found  in  which  seventeen  to  twenty  births  had 
occurred.  In  most  of  the  latter,  very  few  children  are  living 
at  present,  half  of  them  having  died  in  infancy.9 

The  distribution  of  the  population  according  to  sex  and 
age  is  a  significant  factor.  In  Table  I  is  shown  the  total 
male  and  female  population  for  four  years  out  of  the  de- 
cade.  There  is  a  decided  excess  of  males,  the  number  per 

Reservation  workers  claim  that  the  vital  statistics  record  is  in- 
complete for  these  reasons:  Many  Winnebago  mothers  go  unattend- 
ed at  childbirth,  and  frequent  deaths  occur  on  the  reservation  which 
are  not  reported  to  the  local  office.  Although  these  Indians  have 
adopted  modern  burial  customs,  only  occasionally  is  a  burial  permit 
issued. 

'Cf.  below,  8.- 

•A  local  physician  believes  that  much  of  this  mortality  is  due  to 
error  in  diet.  She  says  that  the  Indian  mother's  unreasoning  love 
for  her  children  causes  her  to  nurse  her  babies  incessantly  and  to  feed 
them  everything,  especially  during  the  hot  weather.  Breast  feeding 
is  universal.  The  Indian  mother  as  a  rule  is  well  able  to  nurse  her 
child.  But  one  instance  of  a  bottle  fed  baby  was  met  with  in  this 
study.  When  ill  they  are  given  little  medicine  because  of  its  unpal- 
atableness — Indian  herbs  and  barks  being  preferred..  They  will  afford 
these  little  ones  relief  by  giving  enemas,  using  the  leg  of  a  chicken 
bone  and  a  cow  bladder  as  a  syringe.  Frequent  bathing  of  the  babies 
is  a  common  practice  among  the  Winnebago  mothers. 


Tuberculosis  Among  the  Winnebago 


7 


100  females  varying  from  114.2  to  117.3  while  for  the  In- 
dian population  of  the  entire  United  States  there  are  only 
103.5  males  per  100  females.10 

The  distribution  of  the  Winnebago  population  by  age 
periods  in  1919  shows  some  curious  irregularities.  The  most 
striking  is  the  small  proportion  under  five  years  of  age  and 
the  large  percentage  over  sixty-five  years.  In  a  popula- 
tion which  increases  only  genetically  this  is  not  a  normal 
condition.  Allowing  for  the  careless  recording  of  birth- 
days and  the  tendency  among  primitive  people  to  state  one's 
age  in  terms  of  the  future,  instead  of  the  past,  there  is  still 
an  unusually  small  proportion  of  children  under  five.  This 
is  partially  accounted  for  by  an  epidemic  of  measles*  in  1915. 
The  autumn  was  extremely  cold,  and  as  young  children 
were  not  kept  in  during  their  illness,  most  of  the  smaller 
ones  developed  pneumonia  and  died.  The  record  for  the 
fiscal  year  1915-16  shows  15  out  of  40  deaths,  or  37.5  per 
cent  to  be  under  three  years  of  age.  Again  in  1917-18,  20 
deaths  out  of  51,  or  39.2  per  cent,  were  under  three  years. 
In  addition  to  the  unusual  proportion  of  deaths  among  small 
children  during  this  period,  there  is  the  increased  number 
of  stillbirths  reported  by  volunteer  workers  within  the  past 
five  years.11  These  factors  are  probably  the  most  important 
ones  in  accounting  for  the  unusual  phenomenon  shown  in  the 
age  distribution  for  1919;  viz.,  that  the  proportion  of  the 
population  under  five  years  (11  per  cent)  is  smaller  than  the 
proportion  in  either  of  the  next  two  age  groups. 

In  order  to  determine  the  distribution  for  a  normal  period, 
the  population  for  1913  was  analyzed.  This  year  was  chosen 
because  it  preceded  the  war,  was  more  than  five  years  dis- 
tant from  the  data  for  1919,  and  because  in  that  year  a 
per  capita  payment  was  made  by  the  government  to  the 
Winnebago,  and  hence  the  probabilities  of  a  careful  census 

"Thirteenth  Census,  Abstract,  97. 

"As  a  rule,  stillbirths  and  the  births  of  infants  who  die  when  but 
a  few  hours  old  are  not  reported  on  the  reservation.  The  recent 
increase  in  both  these  groups  is  thought  by  some  to  be  due  to  the  in- 
crease of  venereal  diseases. 


8 


Nebraska  State  Historical  Society 


were  greater.  The  population  for  1913  shows  13.9  per  cent 
under  five  years,  11.9  per  cent  between  five  and  nine  years, 
and  7.2  per  cent  between  ten  and  fourteen  years.  This  is 
more  nearly  what  one  would  expect,  although  the  fact  that 
the  next  three  age  groups  are  larger  than  the  group  from 
ten  to  fourteen  suggests  a  former  sweeping-off  of  children 
similar  to  the  one  within  the  past  five  yars. 

The  average  number  of  persons  per  family  among  the 
Winnebago  is  small.  In  1919,  the  1078  persons  enrolled 
were  distributed  among  291  families,  with  an  average  of 


Table  II.    Showing  Distribution  by  Families  and  Permanent  Houses12 


Year 

Total 
Population 

Families 

Number 

Living  in 
Permanent 
Houses 

1909-1910  

1057 
1086 
1077 
1099 
1090 
1098 
1096 
1105 
1086 
1078 

193  0-1911  

1911-1912  

212 
249 
256 
256 
248 

1912-1913  

1913-1914  

1914-1915  

1915-1916.  

1916-1917  

1917-  1918  

1918-  1919  

291 
291 

258 
262 

but  3.7  persons  per  family.  The  great  majority  of  these 
(262  families)  live  in  permanent  houses,  which  are  slowly 
but  steadily  increasing.  The  remaining  29  families,  or  ten 
per  cent  of  the  total,  either  live  with  relatives  and  friends  or 
travel  about  from  place  to  place. 

The  Winnebago  show  only  slight  intermixture  with  other 
races  or  with  other  tribes.  In  a  total  of  1463  individuals 
whose  family  connection  was  traced,  there  had  occurred 
ten  unions  with  Frenchmen,  eight  with  other  whites,  and 
twelve  with  Indians  of  another  tribe.   These  intermarriages 

"Winnebago  Indian  Agency,  Local  Census  Records,  1909-1919. 


Distribution  by  Age  Periods  and  Sex  Groups  of  the  Winnebago 


S0 


07 

2.0 


60  6* 


55 


jz\  \*.* 


/0 


\*0  <?**>rZf 


Z0 


30   1  If 


~Y£7 

\0.6 


3 


J  ?  S  f  *  J  J  /  <7/SJ'*J-4  7 <f 


Tuberculosis  Among  the  Winnebago  9 


were  equally  divided  between  males  and  females,  the  ma- 
jority of  the  women  (9)  marrying  within  other  tribes,  and 
the  remainder  (6)  with  whites  other  than  French.  One  or 
two  cases  of  intermarriage  with  negroes  was  reported, 
though  none  of  these  came  under  observation.  The  distri- 
bution of  the  present  population  by  degree  of  blood  shows 
over  eighty  per  cent  to  be  full-blood  Indians,  and  some- 
what less  than  ten  per  cent  to  be  more  than  half-blood. 


Table  III.    Showing  Distribution  of  Population  per  Degree  of  Blood13 


Degree  of  Blood 

Male 

Female 

Total 

Per  Cent 

Full-blood   

481 

393 

874 

81.9 

Mixed 

More  than  half  Indian 

52 

53 

105 

9.8 

Half  or  less  Indian  

45 

44 

89 

8.3 

Total   

578 

490 

1068 

100.0 

The  Winnebago  are  "naturally  bright,  intelligent 
people,  more  so  than  the  average  of  Indian  tribes."14  The 
investigator  found  their  knowledge  and  memory  of  family 
affairs  to  be  of  the  highest  order.  As  a  whole  they  under- 
stand the  English  language ;  850  can  speak  and  700  can  read 
and  write  English.  Most  of  these  Indians  have  been  edu- 
cated at  some  government  school  at  a  distance.15  At  pre- 
sent the  majority  of  the  younger  children  are  being  edu- 
cated on  the  reservation.  The  records  show  the  number  of 
children  between  the  ages  of  5  and  18  years  to  be  438 :  213 


"Winnebago  Indian  Agency,  Local  Report,  1919. 

"Quoted  from  Thomas  H.  Roddy  by  Emma  H.  Blair,  Ed.  in 
Indian  Tribes  of  the  Upper  Mississippi  and  the  Great  Lakes  Region, 
II,  298. 

15 The  schooling  averaged  by  the  Winnebago  is  the  seventh  grade. 
A  few  enter  the  high  school  for  one  or  two  years.  A  very  few  have 
graduated  and  attained  prominence. 


10 


Nebraska  State  Historical  Society 


males  and  225  females.  Of  this  number  137  are  incapaci- 
tated for  attendance  at  school  by  reason  of  the  following: 


Male 

Female 

Total 

(a)    111  health  

  3 

5 

8 

(b)    Mental  defect  

  0 

0 

0 

(c)    Physical  defect  

  4  • 

4 

8 

(d)  Marriage   

  4 

6 

10 

(e)    Absence  or  other  reasons 

  58 

53 

111 

63 

68 

137 

The  remainder,  301—144 

males  and  157 

females- 

—are 

eligible  for  school  attendance.  Of  this  number  50  are  in  at- 
tendance at  some  distant  government  school ;  196  are  attend- 
ing the  schools  on  the  reservation  as  follows:  80  in  the 
Dutch  Reformed  Mission  school,  58  in  the  public  schools,  33 
in  the  Episcopal  Mission  school,  and  25  in  the  Catholic 
Mission  school.  Fifty-five  are  unaccounted  for. 

As  to  the  adoption  of  modern  dress,  the  men  are  more 
progressive  than  the  4 women,  having  all  adopted  modern 
attire,  except  that  in  a  number  of  families  both  men  and 
boys  still  adhere  to  the  original  scalp  lock.  The  adult  wo- 
men wear  a  modified  type  of  their  native  dress,  consisting 
of  a  short,  loose  jacket  and  full  skirt  with  a  deep  ruffle  at 
the  bottom.  An  elaborate  fringed  shawl,  usually  black,  is 
an  ever  present  part  of  their  daily  wearing  apparel.  Their 
hair  is  combed  straight  back  and  either  left  hanging  as  a 
braid,  looped,  and  held  in  place  by  bright  ribbons  or  ar- 
ranged in  a  coil  low  on  the  neck.  They  wear  no  hats  or 
corsets.  Moccasins  are  worn  by  many  of  the  older  people. 
A  field  worker  states  that  even  the  young  girls  educated 
along  modern  lines  invariably  drift  back  to  the  Indian 
dress. 

Considerable  progress  along  the  lines  of  Christianity  is 
noted.  In  the  tribal  state  the  religious  customs  and  social 
organizations  were  more  or  less  interwoven  and  over- 
shadowed with  the  mysterious.  Their  belief  in  animism 9  and 

"All  disease  was  regarded  by  them  as  the  visitation  of  some  spirit 
whose  anger  and  wrath  had  been  provoked  or  aroused  by  their  mis- 
deeds. 


Upper — Winnebago  Mother  and  Child 
Lower — Mending  Day 


Tuberculosis  Among  the  Winnebago  11 


the  interpretation  of  all  natural  phenomena  gave  rise  to 
many  songs,  dances,  ceremonies  and  sacrifices.  The  sun 
and  thunder  were  their  principal  divinities.  They  be- 
lieved in  monsters,  witches  and  superhuman  beings ;  also  in 
a  future  state  of  existence.  This  old  paganism  has  been 
unconsciously  influenced  by  their  surroundings  and  by  their 
contact  and  association  with  Christian  missionaries  and 
modern  civilization.  Although  partially  replaced  by  Chris- 
tianity, it  is  still  a  religion  tinged  with  mysticism  which  is 
an  inherent  part  of  the  Indian's  belief.  At  the  present  time 
the  Winnebago  affiliate  with  three  distinct  religious  groups : 
the  Christian  Missions,  the  Mescal-eaters,17  and  the  Medicine 
Lodge,"  or  old  pagan  worshippers. 

Since  1887,  the  Winnebago  have  held  their  land  in  sever- 
alty, a  privilege  granted  to  Indians  only  when  it  is  con- 
sidered that  they  have  reached  the  degree  of  stability  which 
enables  them  to  settle  down  to  the  occupations  of  the  whites. 
The  allotment  law19  gave  to  each  head  of  a  family  160  acres ; 
to  each  other  adult  and  to  each  minor  with  both  parents 
dead,  80  acres ;  and  to  each  minor  with  one  or  both  parents 

"A  "new  religion"  introduced  on  the  reservation  by  the  Otoe  in 
1887,  and  claiming  about  one-third  of  the  Winnebago  in  its  member- 
ship. Its  central  idea  revolves  about  the  use  of  the  mescal-button,  or 
peyote,  a  species  of  cactus  which  grows  near  the  Mexican  border. 
In  1909  the  Winnebago  introduced  the  use  of  the  Bible  into  their 
mescal  services,  some  claim  as  a  cloak  to  protect  them  in  the  use  of 
the  drug,  others  claim  as  a  spiritual  factor  which  has  proved  of  great 
benefit  to  the  Indians.  In  1908  the  Nebraska  Winnebago  sent  a  depu- 
tation to  carry  the  new  religion  to  Wisconsin,  but  failed  in  securing 
results.  For.  different  views  on  the  value  of  the  religion  see  letters 
of  Thomas  R.  Roddy  quoted  by  Emma  H.  Blair,  Ed.  in  Indian  Tribes 
of  the  Upper  Mississippi  and  the  Great  Lakes  Region,  II,  281-2,  298; 
and  article  by  Rev.  J.  A.  Watermulder,  "Mescal,"  in  Report  of  Thirty - 
second  Annual  Lake  Mohonk  Conference  on  the  Indian  and  Other  De- 
pendent People,  (Oct.  19,  1914),  68-76.  The  report  of  the  Superinten- 
dent of  the  Winnebago  Agency  to  the  Commissioner  of  Indian  Af- 
fairs, April  30,  1919  (Ed — L  and  O,  circular  1522,  "Peyote")  is  val- 
uable for  its  judgment  on  this  disputed  point.  For  psychic  interpre- 
tation see  Melvin  R.  Gilmore,  Nebraska  State  Historical  Society, 
XIX,  163-167. 

18 A  secret  society,  ungraded,  entrance  to  which  is  by  initiation. 
To  this  also  belong  those  who  are  not  initiated  but  associated  with 
its  members. 

i9U.  S.  Statutes  at  Large,  XXIV,  388. 


12 


Nebraska  State  Historical  Society 


living,  40  acres.  This  distributed  all  of  the  reservation 
except  about  1000  acres,  half  of  which  lies  along  the 
Missouri  and  is  worthless  for  farming.  All  Winnebago  born 
since  the  allotment  was  made  and  who  possess  land  re- 
ceived it  through  inheritance,  or  gift. 

At  first  all  of  the  lands  were  controlled  and  supervised 
directly  by  the  superintendent  of  the  reservation.  But  as 
rapidly  as  the  Indians  are  considered  capable  of  maintaining 
themselves  and  their  families  independently,  they  are  given 
their  patents  in  fee  which  grant  them  complete  and  ex- 
clusive control  of  their  land.  Up  to  the  present  53  such 
patents20  have  been  issued  and  it  is  the  intention  of  the  gov- 
ernment to  increase  the  number  of  these  as  rapidly  as  pos- 
sible. In  spite  of  the  confidence  of  the  government,  many  of 
the  Winnebago  are  unable  to  resist  the  wiles  of  land  specu- 
lators and  their  own  desires,  and  have  nothing  to  show  for 
their  deed  in  a  short  time  after  they  receive  it.  At  present, 
however,  over  two-thirds  of  the  Winnebago  are  still  govern- 
ment wards. 

As  soon  as  the  Winnebago  became  allotted,  they  were  per- 
mitted to  lease  their  land,  the  leasing  and  the  monthly  collec- 
tion of  rentals  being  conducted  usually  through  the  agency 
office.21  Since  leasing  their  lands  they  have  fallen  into  in- 
dolent habits,  many  doing  nothing.  From  testimony  widely 
different  in  source,  this  seems  to  be  an  indication  of  de- 
generation. In  1865,  the  superintendent  of  the  agency  re- 
ported the  Winnebago  to  be  "characterized  by  frugality, 
thrift,  and  industry  to  an  extent  unequalled  by  any  other 
tribe  of  Indians  in  the  Northwest."22  George  Hill,  for  fifteen 
years  teacher  of  industrial  arts  at  the  agency  school,  says 
"Over  thirty  years  ago,  most  of  the  Winnebago  tilled  small 
patches  of  ground,  raising  some  corn,  oats  and  wheat.  They 
also  did  freighting  by  team,  hauling  goods  from  Dakota 

20Cf.  Superintendent's  Report  to  Commissioner  of  Indian  Affairs, 
1920,  Section  VI,  "Sales." 

21 A  number  of  "semi-competent"  Winnebago  (413)  are  permit- 
ted to  lease  their  land  themselves,  the  approval  of  the  lease  by  the 
agency  office  being  required  to  make  it  legal. 

22Quoted  by  Lawson  in  the  Wisconsin  Archeologist,  VI,  115. 


Tuberculosis  Among  the  Winnebago 


13 


City  to  the  old  Indian  Agency."  Another  witness,  Thomas 
L.  Sloan,  testifies  to  their  former  industry  in  these  words: 
"Many  were  employed  as  laborers  outside  the  reservation 
among  white  people  as  harvest  hands,  wood  choppers  and 
some  of  them  as  farm  laborers.  Frequently  when  owners 
of  land  along  the  Missouri  river  were  likely  to  have  a  cut- 
away by  high  water  they  employed  large  gangs  of  Winne- 
bago Indians  to  cut  the  timber  from  it  before  it  washed 
away."  Steady  and  even  casual  labor  is  no  longer  a  necess- 
ity to  them  for  in  recent  years  the  lands  of  the  Winnebago 
have  increased  greatly  in  value,  making  the  tribe  a  wealthy 
one  and  giving  an  additional  incentive  to  idleness  and  spend- 
thrift habits. 

Although  the  majority  of  the  Winnebago  live  on  farms, 
they  do  little  farming  in  spite  of  the  encouragement  offered 
by  the  government.  Only  about  one-sixth  of  the  land  (8996 
acres)  is  tilled  independently  by  them,  the  remainder 
(54,144  acres)  being  leased  to  the  Whites.  One  of  the  gov- 
ernment officials,  known  as  the  reservation  farmer,  de- 
votes most  of  his  time  to  supervising  the  farming  operations 
of  the  government  wards,  purchasing  seed  and  implements 
and  planning  their  work  for  them.  He  also  advises  with 
those  Winnebago  from  whom  governmental  restrictions 
have  been  removed,  when  requested  by  them.  Another 
official,  known  as  the  agency  farmer,  conducts  a  demonstra- 
tion farm  at  the  agency,  both  as  a  means  of  illustrating 
methods  of  farming  and  as  a  partial  source  of  revenue  for 
maintaining  and  operating  the  agency.  Other  occupations 
were  encouraged  for  a  number  of  years  by  the  teaching 
of  industrial  arts  in  the  government  school  at  the  agency. 

A  further  means  of  encouraging  the  adoption  of  the  white 
man's  industrial  customs  was  tried  by  the  government. 
Many  of  the  Indians  early  gravitated  into  the  untillable 
timbered  portions  along  the  Missouri  river,  where  the  "heir- 
ship" or  unallotted  tribal  lands  lay.  Here  they  reverted  to 
the  primitive  habits  followed  originally  in  their  forest  home. 
In  order  to  induce  them  to  take  up  farming  as  a  settled 


14 


Nebraska  State  Historical  Society 


occupation,  groups  of  good  farm  buildings  were  erected 
on  the  cultivable  lands  in  the  western  part  of  the  reserva- 
tion, and  the  young  and  middle-aged  encouraged  to  take  up 


Table  IV.    Showing  Number  of  Winnebago  Employed  in  Gainful  Oc- 
cupations, September,  1919*3 


Working  on  Reservation 

Working  off  Reservation 

Males 

Males 

Farming  for  selves  

163 

Working  in  Sioux  City  

10 

Ass't  Gov't  farmers  

2 

Trucking  for  Cudahy  Pack- 

Gov't engineer,  stationary. 

..  1 

ing  Co.,  Sioux  City  

10 

Restaurant  keeper  

1 

Fireman  for  Milw.  St.  P.  R. 

Butcher   

] 

R 

JL 

Grocery  clerk  

1 

niprk  in  Gov*r  nffipn  in  Otrln- 
Vw/iciiY  in  vjru  v  u  uillL"  111  vy  Ivla 

Hardware  clerk  

1 

homa   

1 

Carpenters   

S 

T*T*r»'f<i«i«sir»nnT    Vvnll    ■nlatroT*  in 
x  JLV-LCoonjiicii    uaii.    piety  CI  1x1 

Painters24   

4 

major  league  

1 

Shoe  repairer.  

1 

Minister   

1 

Garage  man  

1 

Auto  mechanic  

1 

Total   

24 

Pool  hall  proprietors  

2 

Interpreter  Dutch  Re- 

formed Mission  

1 

Policemen   

.  3 

Total   

186 

Females 

Females 

Music  teacher  

1 

School  teacher  

1 

Stenographers   

3 

Y.  W.  C.  A.  worker  

1 

Matron  at  hospital  

Laundress  at  hospital  

Total   

2 

Ass't  matron  at  hospital  . 

Nurse   

Cook   

Total 

9 

Grand    Total  221 

their  residences  there.  Some  have  remained,  but  many  have 
abandoned  them,  turning  them  over  to  white  lessees  while 
they  have  returned  to  the  heirship  land  where  they  live  in 


"Information  given  by  government  employees. 
""Two  work  all  the  time,  one  one-third  of  the  time  and  one  oc- 
casionally." 


Types  of  Winnebago  Travel 
Upper — On  their  way  to  the  Village 
Middle — Going  Visiting 
Bottom — Their  Modern  Way 


Tuberculosis  Among  the  Winnebago 


15 


little  cabins  and  spend  much  of  their  time  in  idling  and 
dancing. 

The  preceding  table  shows  the  number  of  Indians  em- 
ployed in  gainful  occupations.  Only  210  males  out  of  a 
total  of  390  over  fifteen  years  of  age  are  thus  engaged.  A 
few  women  have  taken  up  work  outside  the  home,  and  are 
represented  in  the  professions.25 

All  the  efforts  of  the  government  have  failed  of  their  high- 
est ideals  chiefly  through  the  inherent  restlessness  of  the 
Indian  nature.  The  Winnebago  spend  a  great  deal  of  their 
time  in  visiting  with  each  other,  which  consists,  says  an 
agency  official,  "in  sometimes  starting  before  breakfast  to 
eat  with  some  relative  or  friend."  Those  who  are  most  in- 
dustrious "seem  to  find  more  time  to  run  around  than  a 
white  man  in  similar  circumstances  would  think  he  could 
afford."26  The  automobile  has  added  to  the  facility  of  travel. 
Many  expensive  cars  are  owned  by  them  from  which  they 
get  an  unusual  amount  of  pleasure.  Travel  to  nearby  vill- 
ages and  to  Sioux  City  add  to  the  native  custom  of  visiting, 
even  less  desirable  forms  of  amusement. 

The  endeavor  to  educate  these  Indians  to  become  a  self- 
supporting  people  appears  to  have  been  fraught  with  small 
return  for  the  large  sums  so  expended  and  the  sacrifice  in- 
volved. The  returned  youth  finds  no  interest  or  occupation 
awaiting  him,  nothing  in  reservation  life  to  elevate  or  main- 
tain the  culture  acquired  while  at  school.  If  there  were 
more  activities  and  if  the  Indians  were  engaged  in  tilling 
their  own  soil,  these  students  would  find  a  field  for  labor. 
Another  factor  which  sets  at  naught  the  education  acquired 
is  the  inability  to  withstand  the  ridicule  of  the  older  Indians 
because  of  attempting  to  follow  in  the  white  man's  path, 

25The  making  of  beautiful  handwoven  rugs  in  colors,  rush  matting, 
basketry,  beadwork,  clay,  bark  and  wooden  vessels  were  favorite  oc- 
cupations of  the  old  time  Winnebago  women.  "Of  all  the  Indian  tribes, 
the  Winnebago  women  do  the  most  beautiful  needlework,  using  the 
finest  thread  and  very  small  stitches.  This  ribbon  work  is  distinctly 
their  own,  as  they  create  and  form  their  own  designs."  Lucy  Palmer, 
Record  Clerk,  Winnebago  Agency.  Very  little  handiwork  is  attempted 
by  the  present  generation. 

MMs.  letter  dated  March  26,  1920. 


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Nebraska  State  Historical  Society 


so  they  soon  drift  back  into  the  old  tribal  ways.  The  racial 
call  is  stronger  than  the  acquired  sensibility. 

In  all  probability  many  of  the  evils  now  rife  on  the  res- 
ervation would  be  alleviated  if  some  plan  could  be  devised 
whereby  every  able-bodied  Indian  were  required  to  till  a 
portion  of  his  own  land,  if  not  otherwise  engaged  in  keeping 
up  the  activities  of  the  reservation.  Labor  is  essential  to 
the  Indian's  civilization  as  it  is  to  the  civilization  of  the 
white  or  the  black  man.  Labor  which  will  benefit  the  In- 
dian, however,  must  be  chosen  for  him,  for  his  own  peculiar 
needs  and  gifts.  It  should  develop  him  along  those  lines 
in  which  he  already  shows  aptitude.  The  work  should  be 
adjusted  to  the  man,  not  the  man  be  compelled  to  take  the 
mould  or  pattern  of  the  work. 

The  Winnebago  were  found  to  be  human  beings  much 
like  ourselves,  yearning  for  an  honest  expression  of  real 
sympathy  and  a  real  feeling  of  humanity  and  true  friend- 
ship. As  an  undeveloped  people,  guided  and  governed  by  a 
developed  people,  they  have  been  weighed  in  the  balance  and 
found  wanting.  We  have  tried  to  interpret  them  in  the 
terms  of  our  own  experience,  forgetting  that  they  have  a 
distinct  individuality  with  a  system  of  values  quite  worth 
while  even  though  unlike  the  values  considered  in  so-called 
civilized  society.  This  arrogant  and  often  wilful  misunder- 
standing is  largely  responsible  for  the  injustice  with  which 
the  Indian  is  treated.  Could  we  regard  him  with  the  eye  of 
an  altruist  rather  than  with  the  eye  of  an  egoist  it  would 
be  better  for  the  Indians — and  better  for  us- 


CHAPTER  II 

INCIDENCE  OF  TUBERCULOSIS 
1.    Basis  of  Data 

In  an  attempt  to  discover  the  incidence  of  tuberculosis 
among  the  Winnebago,  a  study  was  made  on  the  reservation 
extending  through  the  months  of  July  and  August,  1919. 
The  investigation  included  an  examination  of  the  recorded 
data  at  the  agency,  conferences  with  officials  and  volunteer 
workers  on  the  reservation,  and  interviews  with  many  of 
the  Winnebago,  either  at  the  agency  or  in  their  homes.  It 
was  not  possible  to  make  a  complete  survey  of  the  group, 
but  personal  examination  was  made  of  581  Winnebago,  or 
54  per  cent  of  the  total  Indian  population  of  the  reservation, 
while  family  histories  involving  1463  persons  were  secured. 

The  agency  data  include  the  hospital  records,  the  mor- 
tality records,  the  local  census  reports,  and  the  disease  re- 
cords gathered  by  the  Indian .  Office,  all  covering  the  ten 
year  period  beginning  with  the  fiscal  year  July  1,  1909  and 
ending  with  June  30,  1919.  No  one  of  these  series  is  com- 
plete or  entirely  accurate.  Although  the  physicians  in  the 
Indian  service  report  regularly  on  all  diseases  treated,  as 
a  result  of  the  frequent  change  of  physicians  some  cases 
remain  unknown.27  It  is  quite  customary  for  the  Indians 
to  present  themselves  but  once  for  treatment,  depending 
much  for  a  cure  on  their  native  medicine.  Then  too,  by 
reason  of  more  or  less  visiting  among  relatives  and  friends 
in  other  tribes  and  in  other  places  for  indefinite  periods, 
cases  may  easily  remain  undetected.  However,  fairly  com- 
plete medical  statistics  with  uniformity  of  diagnosis  have 
been  kept  through  the  years.  Excellent  daily  records  were 
found  for  the  three  year  period,  1914  to  1917.  A  further 
important  source  for  checking  information  was  the  In- 
dividual History  Card,  which  gives  the  family  connections 


2The  records  show  seven  changes  of  physicians  in  the  past  nine 
years. 


18 


Nebraska  State  Historical  Society 


of  the  majority  of  the  members  of  the  reservation  with  the 
date  of  death  of  relatives  who  are  deceased.  Since  these 
records  are  used  as  a  basis  for  tracing  inheritance,  they 
are  probably  the  most  authentic  records  at  the  agency. 

The  method  of  procedure  for  this  study  consisted  first 
in  securing  information  from  the  hospital  records  as  to  the 
extent  and  ravages  of  tuberculosis.  This  was  followed 
by  personal  interviews  with  the  majority  of  the  living  cases 
whose  names  were  obtained  from  the  medical  records.  In 
many  instances  the  interview  took  place  in  the  home.  With 
the  aid  of  the  local  and  agency  physicians  many  of  these 
living  cases  of  tuberculosis  were  re-examined  together  with 
other  members  of  the  family.  In  a  few  instances  the  exam- 
ination showed  that  some  of  the  cases  had  become  arrested, 
resulting  in  apparent  recovery.  In  addition  the  examination 
resulted  in  the  discovery  of  some  pretuberculous  individ- 
uals arid  incipient  cases  of  tuberculosis.  In  the  further  sur- 
vey of  new  and  suspected  cases  of  tuberculosis,  the  Indian 
hospital28  was  used  as  a  central  place  for  the  observation  and 
physical  examination  of  patients,  though  a  number  of  ex- 
aminations were  made  in  the  homes  and  in  the  office  of  the 
local  physician  at  Winnebago.  The  physical  examination 
included  the  heart,  lungs,  lymphatic  glands,  skin,  skeleton 
and  other  organs  where  suspicious  symptoms  presented. 
A  few  laboratory  tests  and  x-ray  examinations  were  made. 
All  investigations  were  supplemented  as  far  as  possible 
by  an  individual  history  of  each  case,  living  or  deceased. 

No  difficulty  was  experienced  in  coming  into  touch  with 
these  Indians,  who  were  only  too  willing  to  be  of  service.  In 

"The  government  maintains  a  hospital  of  36-bed  capacity  on  the 
reservation  with  a  resident  physician  and  nurse  in  charge.  Treatment 
and  medicine  are  furnished  free  of  cost  to  all  Indians.  A  small 
fairly  well  equipped  operating  room  is  used  for  emergencies  and 
minor  surgery.  Indians  having  bone  or  glandular  tuberculosis  are 
cared  for  at  the  hospital.  Those  having  pulmonary  tuberculosis  are 
admitted  temporarily  or  until  disposition  can  be  made  for  their  re- 
moval to  one  of  the  government  tuberculosis  sanatoria,  of  which 
there  are  thirteen  in  the  United  States.  Most  of  the  Winnebago  are 
sent  to  Toledo,  Iowa,  where  only  those  up  to  twenty-one  are  admitted. 
Above  this  age  they  usually  remain  on  the  reservation  with  little  or 
no  care. 


Tuberculosis  Among  the  Winnebago  19 


visiting  with  them  in  their  homes  or  elsewhere  much  valu- 
able information  regarding  those  physically  ill  among  their 
people  about  the  reservation  was  freely  offered.  So  ap- 
preciative were  they  of  this  health  work  that  they 
voluntarily  presented  themselves  for  physical  examination, 
often  driving  miles  to  convey  or  correct  a  bit  of  informa- 
tion regarding  their  family  history.  In  securing  the  family 
histories  many  additional  cases  of  tuberculosis  now  de- 
ceased were  revealed. 

2.  Mortality  and  Morbidity  Rates 
From  all  sources,  information  was  secured  concerning  237 
cases  of  tuberculosis  within  the  decade  from  1909-10  to 
1918-19  inclusive.29  The  majority  of  these  are  cited  in  the 
hospital  records,  but  there  are  also  included  cases  not  men- 
tioned there,  but  disclosed  by  members  of  the  family  or 
through  physical  examination  by  the  investigator.  Of  these 
cases,  127  were  deceased  at  the  time  the  study  was  made. 

The  deceased  cases  show  an  annual  average  of  12.7  deaths 
from  tuberculosis  during  the  decade,  or  a  mortality  rate  of 
11.7  per  1000.  This  is  a  much  hfgher  rate  than  is  disclosed 
by  the  government  death  records  which  show  only  52  deaths 
from  tuberculosis  in  seven  years,30  an  annual  average  of  7.4, 
or  a  mortality  rate  of  6.8  per  1000.  While  this  latter  ac- 
cords more  nearly  with  that  cited  by  Dr.  Hrdlicka81  (6.6  in 
1907-8)-,  both  are  undoubtedly  too  low.  Since  the  death 
records  omit  all  data  for  three  years  out  of  the  decade,  it  is 
entirely  fair  to  assume  that  the  data  for  the  years  given 


"In  addition  to  this  number,  there  were  found  34  living  cases 
which  may  be  classed  as  pre  tuberculous.  In  10  of  these  cases,  the 
patient  gave  a  history  of  intimate  contact  and  had  some  of  the  minor 
symptoms  of  tuberculosis.  In  24  cases,  the  individual  manifested  no 
positive  symptoms,  but  was  a  suspect  because  undernourished,  un- 
derweight, anaemic,  listless,  and  possessing  little  or  no  resistance  to 
slight  infections.  These  cases  were  found,  as  a  rule,  in  families  in 
which  there  was  tuberculosis. 

,0Cf.  Table  V,  below. 

"Hrdlicka,  Ales.  "Tuberculosis  among  certain  Indian  tribes  of 
the  United  States",  Bureau  of  American  Ethnology,  Bui.  U2,  (1909) ,  5. 


20 


Nebraska  State  Historical  Society 


are  incomplete.  The  mortality  rate  of  11.7  per  1000  among 
the  Winnebago  appears  striking  also  when  compared  with 
other  tuberculosis  rates.  In  the  registration  area32  of  the 
United  States  in  1917,  the  death  rate  was  1.4  per  1000,K 
being  1.2  among  the  whites  and  3.5  among  the  negroes.84 

Of  the  44  Winnebago  deaths  reported  in  1919,  13.6  per 
cent  were  from  tuberculosis;  in  1915,  48.4  per  cent  of  the 
reported  deaths  were  from  this  disease,  and  in  1913,  27.0 
per  cent.  In  the  seven  years  for  which  statistics  are  avail- 
able, 18.8  per  cent  of  the  total  deaths  recorded  among  the 
Winnebago  were  attributed  to  tuberculosis.  This  is  almost 
twice  the  proportion  for  the  registration  area,  which  runs 
about  one-tenth. 

Incomplete  as  are  the  data  for  computing  the  mortality 
rate  from  tuberculosis  among  the  Winnebago,  it  is  much 
more  satisfactory  than  the  basis  of  data  for  the  morbidity 
rate.  For  the  population  at  large,  it  is  estimated  that  there 
are  from  five  to  ten  living  cases  of  tuberculosis  for  every 
death.  On  that  basis  there  would  be  127  cases  of  illness 
each  year  among  the  Winnebago,  a  morbidity  rate  of  116.0 
per  1000.  The  agency  physician  in  1919  estimated  two  cases 
on  the  reservation  for  every  one  discovered  through  the 
hospital— a  total  of  120  cases  or  111.3  per  1000.85  That 
this  estimate  was  not  excessive  is  shown  by  the  fact  that  in 
this  study,  110  living  cases  were  found  at  the  time  of  the 
survey  and  these  among  only  581  persons.  For  this  group 
it  gives  a  morbidity  rate  of  189.3  per  1000.  This  is  doubt- 
less too  high  because  the  cases  were  not  discovered  by  ex- 
aminations made  at  random,  but  mostly  in  families  in  which 
there  was  a  hospital  record.    Assuming  on  the  other  hand 

,2The  registration  area  includes  those  states  in  which  90  per  cent 
of  the  births  and  deaths  are  registered  in  their  respective  State  De- 
partments of  Health  and  accepted  by  the  Bureau  of  Census  at  Wash- 
ington. 

33Bureau  of  Census,    Mortality  Statistics,  1917,  46. 
**Idem,  computed  from  data  on  p.  98. 

^Department  of  the  Interior,  United  States  Indian  Service. 
Annual  Report,  1919.  Dr.  Hrdlicka's  estimate  from  data  collected  in 
1904  was  13.8  per  1000.  Op.  cit.,  4.  For  other  estimates  see  Table  V, 
below. 


Table  V.   Mortality  and  Morbidity  from  Tuberculosis    among  the  Winnebago,  1909-10  to  1918-19" 


1909-  1910. 

1910-  1911. 

1911-  1912.. 

1912-  1913. 

1913-  1914. 

1914-  1915. 

1915-  1916. 

1916-  1917. 

1917-  1918.. 

1918-  1919. 


Total.. 


3opula- 

tiorr" 


1057 
1086 
1077 
1087 
1090 
1098 
1096 
1105 


Number  of  Cases  of  Tuber-  L  Number  of 
culosis  Diagnosed  in  Hos-  |  C««  ^sUmat- 
p      '  nebago. 


43 


210 
73  146 
52  104 
65  125 
52  120 


Deaths  Recorded,  due  to  Tu- 
berculosis of  all  Forms. 


16  13 


2.7 
9.2 
7.2 
13.6 
4.5 


"Compiled  from  local  and  federal  reports. 

"Federal  reports  show  a  slightly  different  enrollment  from  the  local  census  here  used,  averaging  several  points 
higher  for  the  ten-year  period. 

"The  hospital  was  opened  for  reception  of  patients  May  1,  1916. 


Tuberculosis  Among  the  Winnebago 


21 


that  it  included  every  case  on  the  reservation  (which  is 
manifestly  not  the  fact)  the  morbidity  rate  for  the  Winne- 
bago would  be  102.0  per  1000.  The  true  rate  lies  some  place 
between  these  two  extremes,  and  it  is  a  conservative  state- 
ment to  say  that  at  least  one  out  of  every  eight  of  the 
Winnebago  is  suffering  from  some  form  of  tuberculosis, 
either  active  or  latent.86 

3.    Classification  of  Tuberculosis  Cases 

A  classification  of  the  237  cases  as  to  sex  and  age  dis- 
closes these  unusual  facts:  1)  a  greater  frequency  of  in- 
fection among  the  females  than  among  the  males;  2)  a 
larger  proportion  of  infected  children  under  ten  years  of 
age  and  of  youth  between  ten  and  twenty  years  than  is 
found  in  the  total  population  of  the  registration  area.  These 
facts  receive  increased  emphasis  when  it  is  recalled  that  the 
proportion  of  females  and  of  children  under  five  among  the 
Winnebago  is  smaller  than  in  the  general  population.40 

Of  235  cases,41  122,  or  51.9  per  cent,  are  females  and  113, 
or  48.1  per  cent,  are  males."  In  the  registration  area  in 
1917,  only  43.5  per  cent  of  the  total  deaths  from  tuberculosis 
were  among  females,  while  56.5  per  cent  were  among  males. 
The  greater  infection  of  females  among  the  Winnebago  is 
shown  more  strikingly  when  the  number  of  living  cases 
is  compared  with  the  number  of  each  sex  in  the  group. 
Among  496  females,  there  were  found  59  living  cases,  or  a 
female  morbidity  rate  of  118.9  per  1000.  Among  582  males 
were  found  51  cases  or  a  male  morbidity  rate  of  87.6  per 
1000. 

The  age  distribution  of  237  cases  reveals  the  largest  num- 
ber for  any  one  age  group  (44)  under  five  years ;  and  almost 
one-third  the  cases  (85)  under  fifteen  years.    Of  the  total 

8flOf  the  110  living  cases  found,  49  were  active  and  61  were  in- 
active. 

wCf.  supra,  opposite  p.  8. 

"In  two  cases,  the  sex  is  unknown. 

"Of  the  deceased  cases,  62  are  males  and  63  females;  of  the 
living  cases,  51  are  males  and  59  females. 


22 


Nebraska  State  Historical  Society 


cases  classified,  50  per  cent  were  under  twenty  years  of 
age  as  compared  with  17.5  per  cent  for  the  registration 
area  in  191743;  only  35  per  cent  of  the  Winnebago  were  be- 
tween twenty  and  forty  years  as  compared  with  46.9  per 
cent  for  the  registration  area.   The  greatest  morbidity  and 


Table  VI.    Showing  Age  Distribution  of  237  Cases  of  Tuberculosis 
among  the  Winnebago,  1909-1919 


Deceased 


Living 


Morbidity  Mortality 
Rate  Rate 


Winneba- 
go 1919 


58.8 

65.5 

62.9 

17.7 

125.0 

20.8 

206.2 

70.8 

112.5 

123.6 

215.2 

127.8 

141.0 

113.3 

65.5 

105.0 

122.8 

85.7 

94.3 

69.9 

62  63 


51  59 


44 
18 
23 
33 
21 
35 
17 
10 
15 
8 
3 
3 
1 
1 
2 
3 


Grand  Total 


127 


110 


237 


mortality  in  the  group  studied  are  in  the  earliest  age  periods. 
The  disease  is  contracted  in  early  youth  and  over  half  the 
deaths  occurred  under  twenty  years.44 

"The  data  for  the  registration  area  includes  only  deaths  from 
tuberculosis,  and  not  living  cases. 

"Competent  authorities  claim  that  practically  all  tuberculosis 
is  contracted  before  the  tenth  year. 


Tuberculosis  Among  the  Winnebago  23 


This  fact  is  shown  even  more  strikingly  by  a  comparison 
between  the  morbidity  rates  of  the  Winnebago  and  the 
mortality  rates  of  the  registration  area  for  the  various  age 
periods.*5  Allowing  for  the  greater  variation  always  shown 
by  small  numbers,  and  remembering  that  the  Indian  data 
presented  are  only  partial,  the  comparison  is  nevertheless 
interesting.  The  significance  of  the  large  number  under 
five  years  is  reduced  when  it  is  seen  that  the  morbidity 
rate  for  that  age  period  among  the  Winnebago  is  slightly 
lower  than  it  is  for  the  registration  area.  But  the  difference 
in  the  next  three  age  periods  is  little  less  than  startling.  The 
years  from  five  to  twenty  show  the  greatest  immunity  from 
tuberculosis  in  the  population  at  large,  while  the  rate  among 
the  Winnebago  is  from  three  to  six  times  as  large.  The  two 
groups  agree  chiefly  in  showing  the  age  period  from  25  to  29 
to  have  the  highest  rate  although  the  Winnebago  rate  is 
almost  twice  the  rate  for  the  registration  area.  The  Win- 
nebago show  further  variation  in  the  higher  rates  in  the 
upper  age  groups. 

A  few  cases  will  illustrate  the  extremes  of  life  at  which 
tuberculosis  was  found  among  the  Winnebago.  The  records 
show  the  youngest  pulmonary  cases  to  be  those  of  two  little 
girls,  one  succumbing  at  the  age  of  one  month  of  pulmon- 
ary hemorrhage;  the  other,  fourteen  months,  still  living. 
The  oldest  cases  were  two  males,  in  whom  the  process  had 
been  of  many  years'  duration,  and  who  died  at  the  ages  of 
seventy-five  and  eighty  years  of  chronic  fibrinous  tubercu- 
losis. The  oldest  living  subject  seen  was  a  woman  eighty- 
three  years  of  age.  During  the  summer  she  was  living  in 
a  tent  in  the  yard  of  a  relative.  The  sides  of  the  tent  were 
enclosed  with  mosquito  netting  and  the  bed,  consisting  of 
mattress  and  quilts,  lay  on  the  ground.  This  patient  was 
almost  completely  prostrated,  rising  on  her  elbows  occas- 
ionally owing  to  difficult,  and  at  times  labored,  breathing. 

"This  comparison  of  somewhat  dissimilar  data  is  justified  only 
on  the  ground  that  it  is  impossible  to  compute  the  mortality  rate  by 
age  periods  for  the  Winnebago,  and  morbidity  rates  for  the  registra- 
tion area  are  not  available. 


24  Nebraska  State  Historical  Society 


She  was  expectorating  freely  into  an  open  can  about  which 
flies  were  extremely  numerous.  The  scene  presented  a 
picture  of  apparent  neglect,  for  the  sick  and  helpless  aged 
are  often  neglected,  the  rations  furnished  them  being  largely 
consumed  by  relatives  and  visitors.  An  instance  of  the 
kind  happened  in  this  case  when  a  government  worker  call- 
ing at  the  home  found  a  feast  in  progress  from  the  food 
sent  to  this  ill  woman  the  day  previous. 

The  usual  variety  of  forms  of  tuberculosis  was  found 
among  the  237  cases.  Pulmonary  tuberculosis  comprised 
62.4  per  cent  of  the  total,  while  glandular  tuberculosfs, 
which  is  the  prevailing  form  among  many  tribes,46  formed 
only  15.6  per  cent  among  the  Winnebago.  The  hospital  re- 
cords for  the  past  four  years,  however,  show  almost  half 
the  cases  to  be  glandular  while  over  half  the  estimated 

Table  VII.    Forms  of  Tuberculosis  in  237  Cases  among  the  Winne- 
bago, 1909-1919 


Form 

Pulmonary   

Glandular   

Tuberculous  Meningitis. 

Bone   

Other  forms  

Total,  all  forms  


Number  Cases    Per  Cent  Cases 


148  62.4 

37  15.6 

19  8.1 

11  4.6 

22  9.3 


237  100.0 


cases  belong  to  this  type.  Other  forms  included  tuberculosis 
of  the  eye,  ear,  skin,  knee,  liver,  intestines,  peritoneum  and 
diaphragm. 

As  to  the  varieties  of  phthisis  encountered  the  records 
show  three  acute  pulmonary  cases,  all  of  which  ran  a  very 
rapid  course,  terminating  within  three  months  from  the 
onset  of  the  disease,  one  death  occurring  in  the  late  spring 
and  two  during  the  midsummer  months.   One  of  these  sub- 


**Cf.  Hrdlicka  in  op.  ext.,  4. 


Tuberculosis  Among  the  Winnebago  25 

jects47  possessed  with  a  roving  disposition  never  remained 
for  any  length  of  time  in  one  place.  During  the  closing 
weeks  of  his  life  he  lived  in  a  tent,  the  sputum  being  kept 
in  open  cans  and  thrown  out  into  the  yard.  One  of  the  other 
cases,  a  young  man  of  twenty-two  years,  had  no  home 
but  freely  lived  around  in  other  families,  probably  spreading 
infection  as  he  went.  Many  subacute  cases  were  noted  with 
more  moderate  symptoms  and  a  duration  beyond  three 
months.  These  cases  were  for  the  most  part  found  in  young 
adults.  If  they  could  have  been  induced  to  submit  to  ade- 
quate hospital  care  some  might  have  become  arrested  cases, 
as  the  Winnebago  respond  rapidly  under  modern  medical 
treatment.  The  majority  of  the  cases  of  tuberculosis  in 
older  adults  were  of  the  chronic  variety,  with  a  somewhat 
slow  and  irregular  process  and  of  more  than  a  year's  dur- 
ation. 

The  Indians  in  describing  the  condition  of  the  tuber- 
culous subjects  speak  of  them  as  being  up  and  down  at  in- 
tervals for  days,  weeks  and  months  during  their  illness. 
These  periods  of  exacerbation  usually  denote  an  extention 
of  the  infection  to  some  other  part,  either  the  same  organ  or 
other  organs.  The  following  example  well  illustrates  the 
rapidity  of  a  tuberculous  process.  A  young  boy  twelve  years 
of  age  who  had  been  ailing  all  winter  was  up  and  around 
and  attended  school  until  two  months  before  his  death 
when  he  became  bedfast.  He  was  brought  to  the  hospital 
with  an  advanced  case  of  pulmonary  tuberculosis,  both 
lungs  showing  cavity  formation.  The  bridge  of  the  nose  was 
completely  broken  down  and  there  was  a  discharging  ear. 
Pain  in  the  chest,  moist  rales,  cough,  free  expectoration, 
night  sweats,  anorexia,  emaciation,  complete  prostration 
and  death  conclude  the  picture.    The  duration  of  his  ill- 

*7This  was  a  very  improvident  man.  Although  married  he  never 
provided  for  his  family,  but  all  lived  around  with  other  people.  A 
little  son  born  of  this  union  died  at  the  age  of  one  year  of  pulmonary 
tuberculosis.  The  wife  later  developed  a  severe  infection  of  tubercu- 
losis of  the  bowels.  She  recently  died  at  the  age  of  twenty-seven 
years,  after  six  months  of  intense  suffering,  during  which  entire 
time  she  was  bedfast. 


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Nebraska  State  Historical  Society 


ness  was  six  months.  This  case  presents  a  typical  history 
as  revealed  by  the  hospital  records.  The  disease  as  thus 
manifested  shows  that  the  inroads  progress  more  rapidly 
in  the  Indian  than  in  the  white  man.  It  illustrates  the  fact 
that  the  white  man  is  better  able  to  withstand  the  ravages 
of  tuberculosis  on  account  of  an  apparent  greater  resistance. 

Tuberculosis  of  the  glands  of  the  neck  appears  to  be 
quite  prevalent  among  the  Winnebago,  especially  in  chil- 
dren and  young  adults.  Removal  of  the  glands  by  surgery 
has  been  the  most  commonly  adopted  procedure.  In  ten 
cases  of  such  removals  an  apparent  arrest  followed;  in 
four  cases  the  process  continued,  involving  other  glands ;  in 
nine  cases  the  glands  had  suppurated,  one  of  the  cases  re- 
sulting in  a  general  infection  of  the  body,  the  patient  dying 
within  six  months;  in  five  cases  the  glands  were  still  sup- 
purating. One  of  the  most  advanced  cases  observed  was 
that  of  a  bright  young  boy  eight  years  of  age,  in  which  the 
process  had  been  of  more  than  three  years'  duration,  dis- 
charging continuously.  The  removal  of  some  of  the  glands 
and  a  mastoid  operation  have  resulted  in  a  refusal  of  the 
wounds  to  heal.  Several  glands  were  still  discharging  and 
there  was  a  discharging  sinus  into  the  left  ear.  The  swelling 
had  extended  to  the  face,  causing  the  mouth  to  become 
drawn  to  one  side.  This  little  patient  was  faithfully  under- 
going medical  treatment,  but  there  had  been  but  slight  im- 
provement in  his  condition. 

Another  case  was  a  boy  of  fifteen,  in  whom  the  glands 
on  the  right  side  of  the  neck  had  been  removed  a  year  ago. 
All  the  glands  of  the  neck  had  become  enlarged  and  hard- 
ened, encasing  the  neck  in  a  collar  as  it  were.  At  each 
side  was  a  chain  of  glands  extending  down,  probably  in- 
volving some  of  the  mediastinal,  or  chest  glands.  There  was 
at  the  same  time  an  infection  of  the  right  lung  and  a  sunken 
left  clavicle.  Another  young  man  of  twenty-five  had  been 
a  sufferer  from  the  glandular  form  for  ten  years.  During 
this  time  he  had  two  operations  on  his  neck.  The  glands 
were  still  discharging.  Recently  he  developed  an  infection 
of  the  right  lung. 


Tuberculosis  Among  the  Winnebago  27 


Many  cases  of  tuberculous  glands  in  these  Indians  seemed 
to  have  run  a  mild  course,  as  is  evidenced  by  the  frequent 
scars  on  the  necks  of  the  older  Indians  who  are  now  in  ap- 
parently robust  health.  The  theory  advanced  by  English 
observers  that  lymphatic  tuberculosis  is  due  to  bovine  in- 
fection is  not  borne  out  among  the  Winnebago,  as  prac- 
tically no  milk  is  used  by  them.48 

Tuberculosis  of  the  bone  among  the  Winnebago  attacks 
most  frequently  the  tibia  and  the  hip-joint.  One  case  in- 
volved both  the  hip- joint  and  the  fibula ;  another  the  tibial 
epiphysis  and  possibly  the  femur ;  in  another,  the  astragalus 
was  affected.  Two  cases  involved  the  knee-joint.  Tuber- 
culosis of  the  spine,  or  Pott's  disease,  was  found  in  two  cases. 
One  case  was  a  little  boy  who  died  at  the  age  of  two  years ; 
the  other  a  young  girl  of  seventeen,  still  living.  This  young 
girl  seemed  well  until  about  three  years  ago,  when  she 
suffered  a  mild  form  of  anterior  poliomyelitis,  since  which 
time  she  began  to  fail.  In  December,  1918,  she  was  ill  at 
the  government  hospital  with  influenza  and  lobar  pneu- 
monia, following  which  an  open  lesion  in  her  spine  de- 
veloped, discharging  continuously.  A  physical  and  x-ray 
examination  showed  these  findings:  considerable  adenitis 
in  the  superficial  glands  of  the  neck,  right  lung  consolidated 
throughout,  lower  lobe  diminished  breathing,  and  heart 
pushed  to  the  side. 

The  youngest  bone  case  noted  was  that  of  a  little,  quiet, 
lifeless  girl  of  five  years,  in  which  there  was  a  discharging 
sinus  at  the  outer  side  of  the  lower  one-third  of  the  left 
fibula.  The  child  passed  away  after  an  illness  of  five 
months'  duration.  The  oldest  bone  case  was  that  of  a  man 
of  sixty-two  years,  deceased,  in  whom  the  process  was  of 
nearly  fifteen  years'  duration.  Both  the  hip  and  leg  present- 
ed discharging  sinuses  which  occasionally  healed  tempor- 
arily. He  also  had  pulmonary  hemorrhages  and  a  persistent 
cough.   He  always  used  Indian  medicine  and  not  until  the 


"There  are  not  more  than  a  half  dozen  cows  owned  by  Indians 
on  the  reservation. 


28 


Nebraska  State  Historical  Society 


4 


closing  years  of  his  life  when  mastoid  trouble  developed  and 
he  became  bedfast,  did  he  consult  a  physician.  A  niece49  who 
after  the  death  of  her  mother,  was  raised  by  this  man  pre- 
sents one  of  the  severest  cases  of  pulmonary  and  bone  tuber- 
culosis at  the  present  time  among  these  Indians.  The 
former  home  of  this  man  was  a  one-room  house  with  a  dirt 
floor  and  with  two  small  windows.  The  house  contained 
but  two  beds  although  in  the  family  were  seven  persons, 
some  of  whom,  however,  occupied  a  tent  in  the  summertime. 

It  was  found  that  in  infants  and  young  children  the  dis- 
ease is  especially  apt  to  manifest  itself  in  the  meningeal 
form,  the  records  showing  nineteen  cases  of  tuberculous 
meningitis.  Intestinal  tuberculosis  appeared  in  three  cases, 
in  one  instance  as  a  complication  of  a  tuberculous  process 
elsewhere.  In  two  cases  it  seemed  to  have  appeared  as  a 
primary  infection.  In  one  of  these,  a  little  girl  of  two  years, 
shreds  resembling  small  cut  black  threads  found  in  the  stools 
on  microscopical  examination  showed  the  presence  of  tu- 
bercle bacilli.  The  other  was  that  of  a  woman  of  twenty- 
seven  years  who  gave  no  other  sign  of  tuberculous  infec- 
tion. 

Two  cases  of  tuberculosis  of  the  skin  were  found,  one 
a  boy  of  seven  years  at  present  living  on  the  reservation. 
The  other  was  that  of  a  deceased  girl  of  fifteen  in  which  the 
skin  complicated  the  pulmonary  form.  The  records  show 
one  case  of  tuberculosis  of  the  liver  in  a  girl  of  seven  years 
necessitating  an  operation,  the  liver  tissue  on  microscopical 
examination  showing  tubercle  bacilli.  Four  cases  of  tuber- 
culosis of  the  eyeball  have  resulted  in  an  apparent  arrest, 
the  subjects  now  residing  on  the  reservation. 

In  twenty-five  cases  there  existed  multiple  foci  of  in- 
fection of  the  pulmonary  with  the  glandular,  bone,  skin, 
stomach,  kidney  and  intestinal  tuberculosis.  In  twenty-seven 
cases  the  patient  harbored  a  positive  syphilitic  infection. 
The  majority  of  cases  in  tuberculous  adults  were  compli- 

49This  niece  has  a  brother  living  in  Wisconsin  who  is  well  and 
strong,  having  served  in  the  recent  world  war. 


Tuberculosis  Among  the  Winnebago 


29 


cated  with  some  other  morbid  condition,  together  with  the 
use  of  peyote  or  alcohol,  or  by  immoral  mode  of  living. 

Of  the  110  living  cases,  66  are  of  the  pulmonary  or  lung 
consumption  with  the  following  complications:  eleven  with 
the  glandular,  three  with  both  the  glandular  and  the  bone, 
two  with  the  bone,  and  one  with  a  general  lymphatic  in- 
volvement of  the  system.  Thirty  of  the  cases  present  purely 
glandular  symptoms,  two  involve  both  the  cervical  glands 
and  the  bone,  six  the  bones  and  six  others  the  ear,  eye  and 
skin.  In  3^  cases  the  tuberculous  process  appears  to  have 
resulted  in  apparent  recovery. 

A  few  examples  showing  the  inroads  of  tuberculosis  and 
infant  mortality  in  family  groups  follow: 

Group  1.  Parents  and  eleven  children,  two  miscarriages; 
overcrowded,  unsanitary  home ;  father  shiftless,  indifferent, 
did  not  provide  for  family;  mother  dead  at  twenty-nine 
years  of  pulmonary  tuberculosis  and  tuberculosis  of  hip; 
nine  children  dead — four  of  pulmonary  tuberculosis,  two 
suspicious  of  tuberculosis,  three  of  undernourishment;  liv- 
ing— a  girl  of  seven  years  apparently  well,  a  boy  of  five 
years  having  progressive  pulmonary  tuberculosis  and  lym- 
phatic involvement  of  the  glands  of  the  neck. 

Group  2.  Parents  and  children,  unsanitary  home,  father 
a  tuberculous  syphilitic,  mother  pretuberculous ;  three  chil- 
dren dead  of  tuberculosis.  On  mother's  side  one  brother 
dead  of  tuberculosis ;  living,  one  brother  having  pulmonary 
tuberculosis — a  half  sister  with  arrested  lymphatic  con- 
dition. On  father's  side,  an  aunt  and  a  cousin  dead  of  tuber- 
culosis; living,  an  aunt  having  latent  pulmonary  tubercu- 
losis who  also  is  syphilitic,  immoral  and  alcoholic. 

Group  3.  A  subnormal,  low  type  family,  overcrowded, 
unsanitary  home,  habitual  users  of  peyote.  Seven  deaths 
from  tuberculosis,  three  of  which  were  complicated  with 
syphilis,  immorality  and  alcoholism ;  one  suicide  (alcoholic) , 
one  death  due  to  syphilitic  insanity;  ten  children  dying  in 
infancy. 


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Nebraska  State  Historical  Society 


Group  4.  Two  unions,  (same  father) — parents  and 
children.  First  family,  mother  and  six  children  dead  of 
tuberculosis;  second  family,  a  girl  of  fourteen  living,  is  an 
arrested  case — a  girl  dead  in  infancy  of  tuberculosis. 

Group  5.  Parents  (father  syphilitic)  and  seventeen  chil- 
dren, five  living  and  apparently  well — twelve  dead  in  in- 
fancy, cause  unknown.  Very  unsanitary  living  conditions, 
an  old  type  Indian  family. 

Group  6.  Two  unions,  (same  mother) — parents  and 
twenty  children,  of  which  five  are  living  and  seemingly  well  ; 
fifteen  dead,  of  which  there  was  one  death  each  of  tubercu- 
losis, pleuro-pneumonia  and  whooping  cough,  the  remaining 
twelve  dying  in  infancy  chiefly  from  neglect.  This  family 
were  former  users  of  peyote  and  alcohol. 


Modern  Winnebago  Homes 


CHAPTER  III 


FACTORS  AMONG  THE  WINNEBAGO  PREDISPOSING 
TO  TUBERCULOSIS 
1.    Home  Sanitation 

"Home  sanitation  among  the  majority  of  the  Winnebago 
is  extremely  bad,  especially  among  those  having  more  In- 
dian than  white  blood."  Almost  every  Winnebago  family  is 
provided  with  a  well-constructed  frame  house,  containing 
from  two  to  three  rooms,  and  many  five  and  six  rooms, 
having  wooden  floors  and  sufficient  windows  for  proper 
light  and  ventilation.  These  dwellings  are  located  in  sepa- 
rate yards  so  that  there  is  no  crowding.  During  the  summer 
they  are  largely  deserted  for  tents  constructed  after  the 
model  of  their  primitive  bark  huts.  These  tents  are  set 
up  in  the  adjoining  yards  and  many  of  the  household  articles 
moved  into  them. 

In  spite  of  the  fact  that  statistics  show  small  families 
and  sufficient  modern  dwellings  among  the  Winnebago, 
housing  conditions  are  not  all  that  could  be  desired.  Over- 
crowding occurs  due  to  the  desire  of  the  Indians  to  be  with 
each  other.  Very  seldom  does  a  family  live  alone  and  it  is 
a  common  custom  for  several  families  to  huddle  together  in 
two  or  three  rooms.  The  Indian  is  still  imbued  with  his 
old  nomadic  temperament,  he  becomes  restless  and  cannot 
remain  long  in  one  place.  He  is  constantly  visiting  about 
from  place  to  place,  dragging  the  children  with  him.  Every 
family  visited  is  interrupted  in  its  activities,  also ;  thus  the 
Indian's  hospitality  becomes  one  of  the  greatest  drawbacks 
to  his  progress.  Especially  is  this  true  because  the  "home- 
less— or  those  who  leave  husband  or  wife — or  the  sick  can 
always  find  a  home.  It  is  characteristic  of  the  Winnebago 
that  he  will  let  a  sick  Indian — no  matter  how  ill  or  with 
what  disease — come  into  his  house  to  die."60 


Pelkey,  John,  Winnebago  Indian  Policeman. 


32 


Nebraska  State  Historical  Society 


The  Winnebago  seem  to  show  a  direct  relation  between 
housing  and  the  number  of  deaths  per  season  from  tubercu- 
losis. This  is  highest  for  the  spring  months  after  a  pro- 
longed stay  indoors,  increasing  the  symptoms.  Reservation 
workers  state  that  in  cold  weather  the  windows  are  habitu- 
ally closed  and  every  crevice  stopped.  This  living  in  over- 
heated, overcrowded,  ill-ventilated  rooms,  the  sick  in  among 
the  well,  decreases  the  resistance  built  up  during  the  sum- 
mer months  when  these  Indians  spend  most  of  their  time  in 
the  open.  Under  such  conditions  a  tuberculous  infection 
usually  terminates  rapidly  and  fatally.  The  table  below 
shows  that  40.74  per  cent  of  the  deaths  occurred  in  the 
spring  season,  the  greatest  number  during  the  month  of 
May. 

Table  VIII.    Showing  Number  of  Deaths  from  Tuberculosis  by  Seas- 
ons, 1909-1919 

Months  Number         Per  Cent 


December   

January    9  J,  25  23.14 

February    11J 

March   7] 

April   12}  44  40.74 

May    25J 

June    6] 

July   ■.   lOj  25  23.14 

August    9  J 

September    5] 

October    4j>  14  12.96 

November   5J 


Total   108  108  99.98 

The  Winnebago's  ignorance  of  hygiene  and  their  careless- 
ness with  regard  to  sanitary  principles  prevent  their  profit- 
ing from  the  advantages  provided  for  them.  The  women 
show  little  ability  in  making  the  homes  comfortable  and 
healthful,  wearing  apparel,  bedding,  and  kitchen  utensils 


Interior  Views 


Tuberculosis  Among  the  Winnebago 


33 


being  heaped  on  the  floor  against  the  wall.51  The  furniture 
used  is  insufficient  to  provide  system  and  order.  "The 
women  are  always  washing  but  do  not  know  how  to  keep 
things  clean.  For  instance,  a  tub  of  water  is  kept  constantly 
at  hand,  into  which  the  clothes  are  placed  and  washed  as 
needed.  They  do  no  ironing,  merely  smoothing  the  clothes 
with  their  hands."  Since  no  heat  is  applied  either  in  wash- 
ing or  pressing,  the  clothes  cannot  be  so  well  protected  from 
disease  as  under  a  different  method  of  cleansing.  The  per- 
sonal clothing  of  the  Indians  is  kept  cleaner  than  their 
houses ;  yet  they  are  more  careless  about  their  hand  towels 
than  about  their  dish  towels. 

The  use  of  utensils  in  common  is  almost  everywhere  the 
practice.  The  common  drinking  cup  and  the  use  of  the  un- 
washed dishes  of  the  tuberculous  by  small  children  are  im- 
portant factors  in  the  spread  of  infection.  The  use  by  the 
whole  family  of  a  common  dish  and  spoon  is  quite  customary. 
Also,  standing  about  the  house  may  be  several  cans  of  store 
products  in  which  a  common  spoon  serves  for  the  family 
and  visitors.  The  smoking  of  the  "peace  pipe"  in  which  a 
lighted  pipe  is  passed,  uncleansed,  from  mouth  to  mouth, 
provides  a  direct  source  of  infection  from  the  disease.  In 
addition  to  the  common  use  of  eating  utensils,  sleeping 
facilities  are  widely  shared.  Old  and  young,  sick  and  well 
alike,  sleep  in  the  same  beds,  as  do  those  affected  with 
active  tuberculosis,  for  the  sick  are  not  isolated  in  any  way, 
and  consumptives  live  in  the  midst  of  their  families.  The 
typical  way  for  sick  Winnebago  to  sleep  is  with  the  bed 
coverings  drawn  over  their  faces.  The  moisture  from  the 
exhaled  breath,  and  perhaps  direct  expectoration,  causes 
contamination  and  furnishes  a  prolific  source  of  infection 
as  "these  bed-clothes  are  seldom  changed,  aired  or  washed." 
Pallets  on  the  floor  provide  sleeping  accommodations  for  the 
many  relatives  and  visitors. 


61Numerous  homes  were  found  in  fair  condition,  and  a  few  were 
very  well  kept. 


34 


Nebraska  State  Historical  Society 


The  Winnebago  are  extremely  careless  about  the  disposal 
of  human  excreta.  Promiscuous  expectorating  is  a  common 
practice.  In  many  homes  tin  cans,  used  as  spittoons,  stand 
about  the  house  all  day  uncovered.  Only  an  occasional 
privy  was  found  at  the  homes  visited.  Dressings  from 
tuberculous  lesions  are  thrown  about  promiscuously. 

One  of  the  volunteer  field  workers  believes  that  the  cus- 
tom of  giving  away  the  personal  belongings  and  bedding  of 
deceased  persons  to  those  who  have  assisted  with  the  burial 
is  one  of  the  greatest  causes  for  the  spread  of  tuberculosis 
and  other  diseases.  She  says  she  has  seen  bedding  covered 
with  thick  greenish  secretions  given  away;  and  that  there 
is  no  attempt  at  sterilization,  the  pillows  being  merely  aired 
and  the  blankets  washed  in  cool  water. 

Another  worker  cites  a  case  of  suppurating  glands  of 
the  neck  in  which  the  secretions  had  seeped  through  the 
dressings  upon  a  heavy  wool  sweater  the  child  wore  during 
its  illness.  After  the  burial  this  garment  together  with  the 
bedding  was  given  to  a  friend.  An  attempt  by  the  worker  to 
sterilize  the  clothing  resulted  in  absolute  refusal  on  the 
part  of  the  Indians  concerned. 

The  Winnebago  are  a  well-to-do  people  and  whatever  re- 
lation there  may  be  between  their  food  habits  and  tubercu- 
losis is  due  rather  to  their  ignorance  and  social  habits  than 
to  their  failure  to  secure  sufficient  food.  They  keep  very, 
few  cows,  hence  use  little  milk.  Possibly  this  is  as  much 
a  safety  to  them  as  a  hindrance  on  account  .of  the  ease 
witn  which  milk  is  contaminated  and  becomes  a  carrier  of 
disease.  They  have  few  gardens  or  very  little  poultry,  and 
live  largely  on  canned  goods,  meat,  and  bread  purchased 
from  the  store.52  "Their  meals  are  irregular  as  they  eat  at 
all  hours,  exercising  little  or  no  control  over  their  eating  and 

52Decayed  and  infected  teeth  are  very  common  among  the  young- 
er generation  probably  due  to  alleged  "civilized"  diet  since,  in 
his  native  state,  the  Indian  ate  food  that  kept  them  scoured.  Tooth 
brushes  are  little  used  except  by  the  young  who  are  taught  their 
merits  in  school. 


Tuberculosis  Among  the  Winnebago  35 


drinking."  The  dog  is  an  important  and  privileged  member 
of  the  household — a  spoiled  child  with  his  nose  in  every 
receptacle. 

2.    Social  Customs 

Social  customs  which  have  survived  from  primitive  days 
interfere  with  regular  habits  of  living.  Each  burial  is  the 
occasion  for  a  four  days'  feast  and  "every  member  of  the 
clan  is  in  honor  bound  to  render  his  services  or  be  held  in  ill- 
repute.  Religious  festivals,  such  as  the  so-called  mescal 
meetings,  and  the  medicine  dances,  contribute  to  the  general 
demoralization  of  the  people.  The  mescal  meetings  are 
particularly  vicious  in  their  effects,  while  the  night  feasts 
which  accompany  all  these  ceremonies  are  a  physical,  and 
sometimes  moral,  debauch.  Especially  do  the  children 
suffer  from  these  gatherings.  Their  having  to  lie  around 
and  to  sleep  anywhere  on  the  ground,  the  change  of  diet, 
the  consumption  of  great  quantities  of  meat,  especially 
pork,  followed  by  days  of  famine,  lower  their  vitality  and 
make  their  resistance  to  disease  nil.  Incidentally  it  in- 
terferes with  their  regular  school  attendance  and  trains 
them  in  habits  which  hinder  industry  and  the  building  up 
of  their  homes."53 

How  far  the  unstable  marriage  relation  is  a  factor  pre- 
disposing to  tuberculosis  may  be  a  question,  yet  it  is  a  vital 
fact  in  Winnebago  life.  The  primitive  customs  have  been 
broken  down  and  the  restraints  exercised  by  public  opinion 
and  a  tribal  leader  have  been  cast  aside,  nor  are  American 
marriage  laws  enforced  within  the  group.54  No  less  common 
is  the  breaking  of  the  marriage  bond,  "seemingly  without 
the  slightest  hesitation.  This  loose  marital  relation  leads 
to  much  immorality,  not  only  among  themselves  but  with 
low  whites.   Especially  is  this  true  of  the  present  genera- 

"Summary  of  statements  made  by  government  employees. 

"April,  1913,  there  was  enacted  a  law  legalizing  tribal  mar- 
riages and  divorces  prior  to  that  date.  Revised  Statutes  of  the  State 
of  Nebraska,  1913,  p.  465. 


36 


Nebraska  State  Historical  Society 


tion."  Yet  with  all  this  ease  of  marriage  and  divorce,  num- 
erous Indian  couples  remain  true  to  each  other  for  life. 

There  is  practically  no  renewal  of  tribal  blood  as  marriage 
within  the  group  is  the  rule.  This  may  prove  a  factor  in 
the  physical  and  moral  deterioration  of  the  tribe.  By  reason 
of  the  many  matings,  the  whole  tribe  is  more  or  less  related. 
Yet  with  all  this  intermarriage,  but  one  case  of  the  marriage 
of  cousins  was  found  on  the  reservation. 

3.    Use  of  Stimulants 

The  Winnebago,  like  other  Indians,  have  been  addicted 
to  the  use  of  alcoholic  liquors  ever  since  their  first  contact 
with  the  whites.55  Current  report  says  that  until  recent 
years,  they  have  been  a  very  intemperate  people.  The  near- 
ness of  their  reservation  in  Nebraska  to  a  large  and  very 
"wet"  city  has  undoubtedly  increased  the  temptation  and 
the  opportunities  for  surreptitiously  providing  them  with 
the  forbidden  article,  but  the  advent  of  prohibition  has  de- 
creased the  traffic. 

The  use  of  mescal,  or  peyote,  which  has  been  introduced 
among  the  Winnebago  in  recent  years,  is  more  insidious  and 
harmful  than  alcohol  because  it  is  connected  with  religious 
ceremonies,  and  thus  receives  a  religious  sanction.56  Govern- 
ment and  mission  workers  are  vigorous  in  their  efforts  to 
suppress  this  evil,  but  the  white  population  at  large,  ignor- 
ant of  its  effects,  does  nothing  to  discourage  or  prohibit 
its  use.  Mescal  is  a  species  of  cactus  which  grows  wild 
along  the  Rio  Grande  and  southward.  For  many  years  the 
Indians  from  Arkansas  to  central  Mexico  have  used  it  both 
as  a  drug,  especially  for  the  relief  of  fevers  and  hemor- 
rhages, and  as  a  mild  intoxicant. 

"Its  use  was  spread  among  the  Winnebago  under  the 
guise  cf  a  new  religion  and,  at  the  present  time,  more  than 
a  third  of  the  group  are  addicted  to  it.   Reservation  work- 


ed supra,  1. 

E6Cf.  footnote  17,  p.  11. 


Tuberculosis  Among  the  Winnebago  37 


ers  are  a  unit  in  condemning  it  for  its  physical  and  moral 
effects.  Peyote  is  used  as  a  panacea  for  all  the  ills  of  body 
and  soul.  The  drug  either  in  its  dry  state  or  in  the  form 
of  a  tea  is  given  to  all  who  desire  it,  whether  adult  or  child, 
Indian  or  white.  Weekly  meetings  with  all  night  sessions, 
under  the  cloak  of  religion,  partake  of  the  nature  of  lavish 
feasts  with  the  result  that  many  dollars  worth  of  meat 
and  other  edibles  are  consumed.  The  immediate  mental 
effects  are  those  of  an  intoxication  gradually  accompanied 
by  an  incessant  and  wonderful  flow  of  vision  and  music. 
Apparently,  no  unpleasant  reaction  follows  its  temporary 
use,  as  is  the  case  with  so  many  stimulants.  Its  continued 
use  results  in  a  physical  lethargy  which  appears  to  destroy 
ambition  and  energy.  The  permanent  effects  of  the  drug  are 
a  weakening  of  the  powers  of  resistance,  particularly  the 
heart  action.  The  dullness  of  the  children  entering  school 
in  the  fall  is  apparent,  making  them  appear  subnormal.  As 
soon  as  the  drug  is  eliminated  from  their  system  they  are 
able  to  do  work  comparable  with  others  of  their  class."5T 

Local  and  agency  physicians  have  observed  that  child- 
birth of  Indian  mothers  addicted  to  the  use,  is  attended  by 
greatly  decreased  expelling  power  of  the  uterine  muscles 
and  that  infants  so  born  are  lifeless  and  not  easily  revived ; 
that  wounds  do  not  readily  heal ;  that  peyote  users  require 
at  least  twice  the  ordinary  dose  of  stimulants ;  and  that  with 
the  fatal  cases,  many  of  whom  were  apparently  under  the 
immediate  influence  of  the  drug  when  brought  to  the  hos- 
pital, the  most  powerful  stimulants  produced  no  results.  The 
agency  superintendent  states  that  peyote  is  responsible 
for  100  per  cent  of  the  recent  insanity  among  the  Winne- 
bago. 

The  use  of  tobacco  is  very  general  among  both  sexes. 
The  men  smoke,  but  few  chew,  while  the  majority  of  the 
women  chew  as  do  many  of  the  young  children  of  both  sexes. 


"Summary  of  statements  made  by  agency  officials  and  mission 
workers. 


38 


Nebraska  State  Historical  Society 


4.    Allied  Diseases 

The  Winnebago,  like  other  human  beings,  are  subject  to 
a  variety  of  diseases  some  of  which  predispose  to  the  con- 
traction of  tuberculosis.  Among  these  latter  are  catarrhal 
conditions,  influenza  and  venereal  diseases.  George  B.  Grin- 
nell  in  his  Indians  of  Today,  says,  "A  very  large  proportion 
of  the  northern  Indians  apparently  have,  and  perhaps  have 
had,  catarrh,  and  seem  to  show  a  predisposition  to  disease 
of  the  throat  and  lungs/'58 

During  the  winter  of  1918  the  Winnebago  suffered  con- 
siderably from  influenza  and  attendant  pneumonia.  The 
total  morbidity  from  influenza  among  all  Nebraska  Indians 
(2834)  was  861  persons  or  303.8  cases  per  1000  population.89 
Out  of  this  number  there  were  sixty  deaths,  twenty-five 
of  which  were  among  the  Winnebago.  The  records  show 
that  the  per  cent  of  deaths  among  peyote  users  was  twice 
as  great  as  among  the  balance  of  the  population. 

As  to  venereal  disease  the  local  records  show  an  estimate 
of  20  per  cent  syphilitic  and  40  per  cent  gonorrhoeal.  Since 
the  date  of  the  above  estimate  a  clinic  has  been  opened  at  the 
government  hospital  at  which  routine  examinations  for 
venereal  disease  are  to  be  made.  Adequate  treatment  will 
be  forthcoming  to  all  found  infected.  The  findings  of  the 
survey  thus  far  have  been  kindly  contributed  for  use  in 
this  study  through  the  courtesy  of  Dr.  D.  A.  Moore,  resident 
government  physician,  who  says,  "As  to  the  prevalence  of 
venereal  disease  among  the  Winnebago  Indians  I  beg  to 
advise  as  follows:  Out  of  119  Wassermanns,  including  100 
adults  and  19  children,  the  findings  show  55  adults  and  5 
children60  with  positive  reactions  with  more  than  50  per 
cent  a  4-plus  positive;  45  adults  and  14  children  with  neg- 
ative reactions.    Other  venereal  infections  including  39 

58Cf.  also  Report  of  Commissioner  of  Indian  Affairs  for  the  years 
1854,  1855,  1860,  1867,  1869  and  1870. 

59£7.  S.  Public  Health  Report,  XXXIV  (Oct.  17,  1919),  2298-2300. 

60A11  children  were  under  sixteen  years  of  age  with  the  exception 
of  two,  who  were  under  eighteen. 


Tuberculosis  Among  the  Winnebago  39 


adults  and  12  children  show  46  positive  and  5  negative.  This 
makes  a  total  of  170  tests  representing  130  individuals, 
91  of  whom  show  some  infection.  Many  were  tested  for  two 
or  three  diseases  and  show  two  or  three  infections.  In  ad- 
dition to  this  we  have  a  number  under  treatment  diagnosed 
by  clinical  signs.  To  a  certain  extent  many  were  selected 
cases,  having  been  tested  because  of  some  suspicious  cir- 
cumstances, but  a  large  number  are  purely  routine  tests 
taken  as  the  Indians  came  to  the  hospital  as  patients  for 
other  diseases  and  were  examined  for  same.  I  feel  as  though 
I  am  not  too  generous,  due  to  results  of  these  tests  and  my 
observation,  by  saying  that  60  to  70  per  cent  of  the  Winne- 
bago on  this  reservation  are  suffering  with  venereal  disease 
either  congenital  or  acquired."  Dr.  Moore  further  states 
that  if  all  Indians  found  infected  with  venereal  disease  could 
be  induced  to  submit  to  adequate  medical  treatment,  tuber- 
culosis would  be  given  a  body  blow. 

Another  physician,  Dr.  Ralph  Ross,  who  has  been  con- 
nected with  the  Indian  service  24  years,  says :  "In  the  three 
months  I  was  among  the  Winnebago  and  Omaha  I  saw  more 
venereal  disease  than  in  the  sixteen  years  I  was  among  the 
Sioux  and  the  six  years  among  the  Apache.  These  diseases 
are  on  the  increase  and  some  drastic  means  should  be  taken 
both  for  treating  and  preventing  the  spread  of  syphilis  and 
gonorrhoea." 

The  government  and  volunteer  field  workers  on  the  reser- 
vation state  that  progress  in  health  education  is  slow  and 
difficult.  The  children  carefully  guarded  by  them  during 
the  school  year  leave  at  the  end  of  the  term  to  spend  the 
summer  months  with  the  parents,  only  to  return  in  the  fall 
in  an  undernourished,  anaemic  and  non-resistant  physical 
condition.  Difficulty  with  the  adults  too  is  experienced, 
their  inherent  restlessness  rebelling  at  any  long  continued 
restraint.  Particularly  is  this  noticeable  with  the  hospital 
cases.  Frequently  while  undergoing  treatment  they  rise 
from  their  beds  and  leave  without  warning.  The  citation 
of  a  few  specific  cases  may  be  of  interest  in  showing  how 


40 


Nebraska  State  Historical  Society 


little  the  Indian  realizes  the  seriousness  of  tuberculosis, 
the  manner  of  transmission  or  the  effects  of  careless  living, 
and  how  great  is  the  difficulty  experienced  in  helping  them. 

About  three  and  one-half  years  ago  a  field  nurse  found 
a  boy  of  twelve  years  living  with  a  number  of  old  primitive 
Indians  in  a  small,  dirty,  overcrowded  bark  hut.  This  boy 
had  at  that  time  a  tuberculous  knee  which  was  being  cared 
for  by  an  old  Indian  medicine  woman.  She  was  using  the 
ground  root  of  milk  weed  as  a  dressing,  binding  the  knee 
tightly  so  that  drainage  was  impossible.  They  would  not 
let  the  worker  do  anything  for  him.  The  next  development 
was  an  ischio-rectal  abscess.  They  were  finally  persuaded 
to  have  the  child  enter  the  hospital  for  treatment.  He  re- 
mained six  months  during  which  time  he  showed  great  im- 
provement, gaining  in  flesh  and  becoming  healthy  looking. 
At  the  pleading  of  the  relatives  and  on  promise  to  permit 
him  to  return,  he  went  home  for  a  visit  and  was  kept  there 
by  force.  He  ran  away  but  his  clothes  were  hidden  so  that 
he  would  have  to  remain  at  home.  The  next  development 
was  pulmonary  tuberculosis. 

About  a  year  ago  a  new  three  room  house  was  built 
which  was  no  better  as  to  cleanliness  than  the  bark  hut. 
The  boy  spent  his  time  between  the  two  homes.  This 
family  was  very  careless  about  the  tuberculosis  dressings, 
throwing  them  uncovered  just  outside  the  door.  Never 
using  screens,  the  house  was  filled  with  flies.  Soon  after, 
the  mother  of  the  boy  developed  pulmonary  tuberculosis. 
Although  having  been  warned  repeatedly  as  to  the  care  of 
the  sputum  they  still  continued  to  expectorate  on  the  floor 
or  into  little  cloths  which  were  hidden  under  the  pillow. 
This  mother  and  son  died  last  spring  within  a  month  of 
each  other.  The  grandfather  of  this  boy  died  of  tuberculosis 
many  years  ago.  The  grandmother  has  had  many  cases  of 
tuberculosis  to  care  for  in  her  home,  most  of  whom  were 
relatives.  She  herself  presents  an  arrested  case  of  phthisis 
bulbi  (tuberculosis  of  the  eyeball),  the  eye  having  been  re- 
moved several  years  ago. 


Upper — Native  Tent  Abode — A  Temporary  Shelter  While 
Visiting  Friends 

Middle — Primitive  Bark  Hut — The  Only  One  Still  Remaining  on  the 

Reservation 

Lower — Summer  Quarters — A  Common  Sight  on  the  Reservation  in 
the  Summer  Time 


Tuberculosis  Among  the  Winnebago  41 


Another  case  showing  the  facility  of  infection  was  a 
woman  far  advanced  in  the  disease  having  a  pulmonary, 
glandular  and  general  infection  of  the  system,  who  had 
living  with  her  a  half-brother,  four  years  of  age.  At  a  table 
in  a  home  where  she  was  visiting  she  was  seen  to  pass  a 
chicken  leg  from  which  she  had  been  eating  to  this  young 
child.  She  was  also  using  for  the  family  sugar  bowl  the 
same  spoon  that  she  had  been  using  in  her  mouth.  This 
woman  presents  one  of  the  severest  cases  of  pulmonary 
tuberculosis  and  lymphatic  adenitis  on  the  reservation. 
Still  she  continues  to  live  about  in  many  homes  in  which 
there  are  young  children.  She  is  married  to  her  second 
husband  who  shows  an  incipient  pulmonary  infection. 

The  effect  of  careless  living  is  shown  in  the  case  of  a 
comely  young  lad  of  eighteen  years  who  heedlessly  roams 
about  on  the  reservation  and  to  nearby  points.  He  pre- 
sents a  case  of  active,  progressive  pulmonary  tuberculosis, 
has  enlarged  cervical  glands  and  healed  skin  lesions  over  the 
body.  He  carries  a  specific  infection  and  has  lead  an  im- 
moral life  since  fourteen  years  old. 

The  effect  of  other  illnesses  and  apparent  parental  neg- 
lect as  contributing  factors  is  shown  in  the  case  of  a  young 
girl  of  thirteen  who  was  compelled  to  leave  school  because 
of  latent  glandular  and  pulmonary  tuberculosis  involving 
both  lungs.  She  has  had  in  succession  smallpox,  whooping 
cough,  measles,  mumps,  scarlet  fever,  a  discharging  ear  and 
infected  eyes.  Although  in  attendance  at  one  of  the  govern- 
ment schools  this  child  has  not  always  had  a  permanent 
home,  due  to  the  mother's  promiscuous  Hying  with  many 
men,  causing  the  child  to  be  shifted  about  in  various  homes. 

To  one  individual  23  years  of  age  may  be  traced  several 
cases  of  tuberculosis  because  of  intimate  contact  and  close 
association.  This  young  man's  infection  is  of  nine  years' 
duration  and  at  the  present  time  is  active  to  a  certain  de- 


42 


Nebraska  State  Historical  Society 


gree.  He  has  had  two  operations  on  his  neck,  one  at  14  and 
one  within  the  last  year.  Although  showing  some  improve- 
ment he  still  presents  a  very  bad  lymphatic  and  pulmonary 
condition.  There  is  at  the  same  time  a  discharging  sinus 
below  the  left  knee.  He  is  living  in  a  home  in  which  there 
are  several  cases  of  tuberculosis  and  with  congested  sleep- 
ing quarters,  though  this  is  one  of  the  few  orderly  and 
well  kept  Indian  homes  on  the  reservation.61 

SUMMARY 

In  determining  the  cause  of  tuberculosis  among  the  Win- 
nebago no  single  factor  can  be  isolated.  "The  Indians  are 
creatures  of  environment.  True  to  the  instincts  of  their 
nature  they  like  to  live  the  free,  roaming,  profitless  life  of 
the  Indian.  To  teach  them  the  arts  of  civilized  life  and  in- 
duce them  to  abandon  the  habits  of  their  ancestors  for 
ours  almost  amounts  to  a  change  of  their  nature."  They 
were  a  primitive  people.  In  their  native  state  they  were  out- 
door individuals.  They  lived  in  the  open,  they  worked  in 
the  open,  they  slept  in  the  open.  They  were  then  a  select 
race,  as  only  the  strongest  were  able  to  survive  the  rigors 
and  hardships  accompanying  the  wandering  and  wigwam 
life  of  the  old  Indian  days. 

In  emerging  from  this  early  tribal,  nomadic  life  to  that 
of  civilization  the  Indians  have  been  placed  in  an  environ- 
ment new  and  unfamiliar,  without  protection  being  thrown 
about  them.  First  of  all  then  consideration  must  be  given 
to  the  changed  habits  of  the  Indians — their  present  in- 
activity and  change  of  diet — the  transition  from  the  old, 
free,  active,  vigorous  outdoor  life  full  of  interest  and  ex- 
citement, to  the  indoor,  inactive,  shut-in  modern  life  with 
food  which  they  do  not  know  how  to  prepare  and  to  which 
they  are  unaccustomed. 

61As  a  result  of  this  study  of  tuberculosis  among  the  Winnebago 
the  Nebraska  Tuberculosis  Association  has  established  admission  of 
these  Indians  to  the  State  Tuberculosis  Hospital  at  Kearney,  Ne- 
braska. Ten  Indians  have  been  admitted,  all  but  one  (deceased)  are 
showing  favorable  progress.  Cf.  also  Superintendent's  Report 
to  Commissioner  of  Indian  Affairs,  1920,  Section  11,  "Health." 


Tuberculosis  Among  the  Winnebago  43 


In  the  old  days  the  Indians  dwelt  in  tepees  or  bark  lodges, 
with  an  opening  at  the  top  and  the  fire  in  the  center,  making 
ideal  ventilation.  When  these  abodes  and  their  surround- 
ings became  intolerable  for  living  purposes,  they  were 
picked  up  and  moved  to  fresh  ground.  The  spot  vacated 
cleaned  up  of  itself.  At  the  present  day,  houses  have  been 
substituted  for  primitive  lodges  without  the  Indians  having 
been  taught  how  to  live  in  them.  As  the  houses  can  not  be 
moved  as  were  the  tepees,  and  nature  not  having  the  op- 
portunity to  clean  up  the  unsanitary  conditions  as  they 
arise  and  multiply,  the  occupants  continue  to  live  on  in  the 
midst  of  the  filth  with  all  their  native  ignorance  and  care- 
lessness. 

Again  the  Indian  appears  to  have  slight  powers  of  re- 
sistance to  tuberculosis  because  the  disease  is  new  to  him. 
Races  long  removed  from  infection  are  particularly  sus- 
ceptible to  disease.  "Some  of  the  white  races  have  acquired 
a  certain  degree  of  resistance  to  tuberculosis  through  in- 
heritance (?)  and  almost  universal  infection"  and  have  be- 
come to  some  extent  immune.62  The  Indian  having  never 
experienced  the  disease  until  within  recent  years  and  not 
having  had  sufficient  time  for  the  establishing  of  anti- 
bodies to  insure  to  any  limited  degree  an  acquired  im- 
munity, is  extremely  susceptible  to  the  disease,  and  when  in- 
fection does  occur  it  is  very  rapid  and  usually  fatal. 

Then,  too,  Indians  are  not  sensitive  to  suffering  in  them- 
selves or  in  other  people,  not  even  near  relatives.  This  is 
characteristic  of  primitive  people  throughout  the  world. 
Conditions  of  life  are  hard  under  aboriginal  environment. 
Old,  crippled  and  sick  persons  perish.  The  strong  and  well 
are  compelled  to  care  for  themselves.  Practice  of  self  pre- 
servation through  centuries  has  formed  habits  of  behavior 
toward  weaker  members  of  a  tribe  which  surprise  and 
shock  civilized  men  and  women. 

The  frequent  removal  of  the  Winnebago  to  ill-adapted 
and  unsuitable  environments  preceding  their  settlement  in 

02Rosenau,  Milton  J.  Preventive  Medicine  and  Hygiene,  Third 
Edition,  147. 


44 


Nebraska  State  Historical  Society 


Nebraska,  is  a  factor  which  of  itself  has  been  detrimental 
to  Indian  progress  and  physical  welfare.63  The  contacts 
and  associations  with  unprincipled  and  depraved  whites,  the 
unlawful  sex  relations,  the  abuse  of  intoxicants  and  the 
ready  access  to  the  influence  of  city  life  have  all  proved  in- 
jurious to  health  and  morals. 

Connected  with  the  foregoing  are  the  personal  factors: 
overcrowded,  ill-ventilated  and  unsanitary  homes;  unclean 
personal  habits;  the  periodical  feasts  and  famine;  and  the 
living  about,  with  its  consequent  parental  irresponsibility 
and  neglected  childhood.  Through  plural  marriages64  are 
offered  increased  opportunities  for  the  mating  of  the  tuber- 
culous with  the  tuberculous  and  with  the  alcoholic  and 
syphilitic,  frequently  all  these  conditions  being  found  in  one 
or  both  parents.  The  dissipation  and  unwholesome  living 
of  the  youth,  the  fact  that  sixty  to  seventy  per  cent  of  the 
Winnebago  harbor  a  specific  infection ,  and  the  indolence  and 
improvidence  of  many  of  the  men,  present  a  condition  favor- 
able to  the  tendency  toward  and  contraction  of  tuberculosis. 

The  Winnebago  are  passing  through  a  long  trial  which  is 
to  determine  whether  any  remnant  of  the  tribe  shall  sur- 
vive. Such  survival  will  arise  only  from  the  presence  of 
enough  individuals  in  each  generation  who  will  keep  them- 
selves free  from  the  vices  and  practices  which  are  certain 
to  result  in  the  extinction  of  many  of  their  tribal  families. 
Enough- young  men  and  women  must  be  found  willing  to 
adopt  the  advice  of  medical  and  sanitary  science  and  live 
lives  which  will  enable  them  to  beget  and  rear  children  free 
from  the  taints  which  are  destroying  so  many  members  of 
the  tribe. 

The  present  health  conditions  on  the  reservation  of  this 
once  important  tribe  of  Indians  become  a  matter  of  serious 
concern,  for  no  portion  of  a  population  directly  suffers  un- 
less the  remainder  indirectly  suffer  with  it.  Tuberculosis 
is  as  great  a  menace  to  the  white  population  as  to  the  In- 

63Cf.  Report  of  the  Commissioner  of  Indian  Affairs,  1846-47,  104. 
64Not  polygamous  marriages.    Cf.  footnote  65,  p.  46. 


Tuberculosis  Among  the  Winnebagv  45 


dians  themselves,  for  there  are  from  two  to  three  times  as 
many  white  people  living  on  the  reservation  as  there  are 
Indians.  The  Winnebago  are  beginning  to  move  to  the 
cities  where  they  take  up  work  in  the  packing  houses.  Thus 
far  they  are  only  trucking,  but  soon  they  will  be  handling 
foodstuffs. 

It  seems  wise  to  proceed  energetically  at  once  to  pro- 
phylactic measures — to  the  introduction  of  activities  tend- 
ing toward  better  health  and  better  morals,  and  through 
this  protection,  which  is  really  the  inherent  right  of  the 
Indian,  to  protect  also  the  white  population  which  comes 
directly  or  indirectly  in  contact  with  him.  The  health  situ- 
ation is  no  longer  an  Indian  problem,  but  a  community 
problem — a  public  health  responsibility. 


APPENDIX 


Family  Distribution  of  Tuberculosis 

In  the  preceding  pages  we  have  discussed  the  incidence 
of  tuberculosis  among  the  Winnebago  based  upon  the  par- 
tial records  covering  a  ten-year  period.  A  second  method 
of  determining  its  occurrence  was  attempted  by  securing 
histories,  as  nearly  complete  as  possible,  of  some  of  the  fam- 
ilies in  which  cases  were  found.  The  group  studied  in- 
volves 110  individual  families  or  over  one-third  the  families 
on  the  reservation. 

Many  complex  relationships  were  encountered.  The 
smallness  of  the  group  and  the  fact  that  there  is  no  immi- 
gration and  little  intermarriage  with  outside  persons,  causes 
numerous  unions  between  relatives.  Of  the  110  single 
families,  72  constitute  a  marriage  tangle. 

More  baffling  still  is  the  fact  that  many  of  the  Winne- 
bago enter  into  marital  relations  with  a  great  number  of 
individuals.65  Technically  polygyny  is  not  practiced  except 
in  rare  instances,  although  the  absence  of  legal  control  of 
domestic  relations  makes  divorce  and  subsequent  re- 
marriage a  very  easy  procedure,  and  encourages  unions  so 
unstable  as  to  amount,  at  times,  to  promiscuity.68  Num- 
erous examples  were  found  of  three  and  four  marriages, 
some  of  six,  eight,  or  ten,  while  others  are  reported  as 
"many  husbands"  or  "many  wives",  the  exact  number  not 
being  clear  in  the  memory  of  the  relator.  Thus  the  110 
single  families67  include  21  families  with  children  of  the  half 

"The  majority  of  these  unions  are  marriage  by  tribal  custom, 
which  is  simply  the  abandoment  of  the  spouse  and  perhaps  the  im- 
mediate marriage  by  Indian  custom  of  another,  merely  the  selecting 
of  a  mate  and  living  together  by  mutual  consent. 

66Cf.  footnote  54,  p.  35. 

67By  the  single  family  is  meant  the  primitive  social  unit — the 
marriage  or  pairing  between  one  man  and  one  woman,  though  the 
union  be  often  transitory  and  the  rule  frequently  violated.  Cf.  How- 
ard, History  of  Matrimonial  Institutions,  I,  89-110. 


Tuberculosis  Among  the  Winnebago  47 


blood ;  13  families  in  each  of  which  there  are  children  by  the 
same  father  but  of  different  mothers;  and  8  families  in 
each  of  which  there  are  children  of  the  same  mother  but  of 
different  fathers.  Included  also  in  the  110  families  are  10 
unions  with  no  offspring.68 

A  few  illustrations  showing  the  distribution  of  disease 
and  the  complexity  and  freedom  of  the  marriage  relations 
follow.  In  one  case  a  man,  recently  deceased,  infected  with 
syphilis,  has  had  six  wives.  The  first  wife  is  still  living 
and  is  at  present  mated  to  her  sixth  husband.  The  second 
wife  died  of  pulmonary  tuberculosis  and  was  also  infected 
with  syphilis ;  the  third  wife  gave  birth  to  a  boy  who  died 
of  pulmonary  tuberculosis  at  the  age  of  twenty  years ;  and 
the  fourth  wife  who  had  previously  been  married  many 
times  and  given  birth  to  many  children,  became  with  this 
husband  the  mother  of  two  tuberculous  children.  She  is 
now  married  to  a  man  who  was  the  father  of  two  deceased 
tuberculous  children  by  a  former  marriage. 

In  a  second  case  a  tuberculous  syphilitic,  being  also  alco- 
holic and  immoral,  was  married  to  two  tuberculous  women. 
The  first  wife  now  deceased,  was  also  infected  with 
syphilis.  She  gave  birth  to  ten  children,  all  dying  in  in- 
fancy. The  present  wife  having  had  many  husbands  and 
given  birth  to  several  stillborn  children  became  with  one 
husband  (family  history  free  of  tuberculosis)  the  parents 
of  a  child  which  is  pretuberculous,  requiring  careful  atten- 
tion. The  union  of  this  latter  husband  to  an  apparently 
healthy  woman  of  another  tribe  (previously  married  and 
having  borne  four  healthy  children)  has  resulted  in  three 
healthy  offspring. 

In  another  case  a  previously  married,  tuberculous  woman 
was  wedded  to  a  twice  previously  married  tuberculous  man, 
one  of  his  former  wives  and  a  child  having  died  of  tubercu- 
losis. Very  shortly  after  the  demise  of  the  above  third 
wife,  the  husband  mated  with  a  fourth  spouse. 


0SThe  writer  is  indebted  to  Professor  George  Elliott  Howard  for 
valuable  assistance  rendered  in  classifying  family  relationships. 


48 


Nebraska  State  Historical  Society 


The  family  relationships  of  the  group  studied  have  been 
traced  through  from  three  to  seven  generations.  Owing 
to  the  great  frequency  of  marriage  the  line  of  descent  is 
constantly  broken.  To  the  extent  that  it  was  possible  to 
secure  family  histories,  the  line  of  descent  is  traced  chiefly 
through  the  female,  and  whenever  possible  through  the 
male  line."  These  relationships  are  to  be  graphically  re- 
presented in  the  form  of  pedigree  charts  depicting  the 
family  distribution  of  tuberculosis.  Fifteen  distinct  trees 
are  in  the  process  of  construction.  These  charts  with 
eugenical  analyses  will  appear  in  a  later  publication. 


